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Supraglottische Beatmungshilfen in der Notfallmedizin

Supraglottic airway devices in emergency medicine

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Zusammenfassung

Die Sicherung der Atemwege bei Notfallpatienten ist zentrales Kriterium einer suffizienten präklinischen Therapie. Das zuverlässige Beherrschen alternativer Techniken zur Sicherung der Atemwege gestattet die Oxygenierung und Ventilation des Patienten, wenn Routineverfahren—in der Regel die endotracheale Intubation—nicht erfolgreich sind. Mindestens eine der im Folgenden diskutierten supraglottischen Beatmungshilfen sollte deshalb für jeden Notfallpatienten unmittelbar zur Verfügung stehen.

Der Kombitubus ebenso wie der EasyTube besitzen 2 Lumina und können sowohl blind manuell als auch mit Hilfe eines Laryngoskops platziert werden. Larynxtubus und Larynxmaske ermöglichen eine Ventilation des Patienten nach manueller Positionierung. Jede dieser supraglottischen Beatmungshilfen kennzeichnet bestimmte Vor- und Nachteile, die vor dem Einsatz bei Notfallpatienten gegeneinander abgewogen werden müssen. Wegen der großen Vielfalt der zur Verfügung stehenden Techniken bedarf es generell eines planmäßigen Vorgehens im Rahmen eines Algorithmus. Dieser dient neben der Vorbereitung der Ausrüstung und der Schulung des Personals auch einer effizienten Entscheidungsfindung während des Handelns unter Zeitnot.

Abstract

Complications related to airway management in the prehospital setting are frequent and, because of the importance and vulnerability of the ventilatory system, can be life threatening within a very short time. Therefore, airway management ensuring oxygenation and ventilation of the patient as well as protecting the airway against aspiration is perhaps the key component in the treatment of any prehospital emergency patient. Alternatives to endotracheal intubation such as supraglottic airway devices should be available immediately if standard techniques fail.

Both the esophageal-tracheal Combitube and the EasyTube consist of two lumina; therefore, ventilation of the patient can be provided after oesophageal as well as tracheal placement of its tips. Both devices can be positioned by the help of a laryngoscope or using a blind, manual technique. Laryngeal tube and laryngeal mask enable ventilating a patient after manual placement of the devices. For all supraglottic devices, individual advantages as well as disadvantages are to be discussed for the use in emergency patients. Because of the number of existing techniques, a systematic approach following an algorithm is recommended to manage the difficult airway. The algorithm enables to prepare the equipment well in advance and train the personnel. Most importantly, algorithms serve as a guideline to efficiently solve airway management problems in emergency patients.

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Interessenkonflikt:

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma/Firmen hin: die Autoren haben klinische Studien zur Evaluierung des EasyTubes durchgeführt, die von Teleflex Medical unterstützt wurden.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, Johannes Gutenberg-Universität Mainz

    T. Piepho, A. Thierbach & C. Werner

  2. Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Langenbeckstraße 1, 55131, Mainz

    T. Piepho

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  1. T. Piepho
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  2. A. Thierbach
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  3. C. Werner
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Correspondence to T. Piepho.

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Piepho, T., Thierbach, A. & Werner, C. Supraglottische Beatmungshilfen in der Notfallmedizin. Notfall & Rettungsmedizin 8, 123–128 (2005). https://doi.org/10.1007/s10049-004-0712-4

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  • DOI: https://doi.org/10.1007/s10049-004-0712-4

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