Résumé
L’intubation trachéale en urgence est associée à une plus forte incidence de difficultés. Cette difficulté accrue est elle-même associée à une augmentation des complications et de la mortalité. La recherche de critères prédictifs d’une intubation difficile est plus délicate en urgence et moins pertinente. Le recours à des alternatives à l’intubation orotrachéale, l’optimisation de la procédure et l’utilisation de procédures spécifiques limitent la survenue et les conséquences d’une intubation difficile. Le choix d’un matériel, une organisation et un entraînement éprouvés permettent de réduire les conséquences d’un cas d’intubation difficile, prévue ou non. Les nouveaux dispositifs de « vidéoscopie » semblent supérieurs aux techniques classiques d’intubation, en particulier en cas d’intubation difficile. Ils devront très certainement trouver leur place dans les prochains algorithmes de prise en charge des intubations difficiles en urgence, voire, plus globalement, des intubations en urgence. Chaque structure potentiellement confrontée à l’intubation en urgence devrait d’ores et déjà s’interroger sur son choix de matériel et sa stratégie.
Abstract
Tracheal intubation in emergency is associated with a higher incidence of difficulties, resulting in increased incidence of complications and mortality. The search for criteria predicting difficult intubation is more difficult and less relevant. The use of alternatives to tracheal intubation, such as optimization of the procedure, and use of specific procedures limit the onset and consequences of a difficult intubation. The choice of material, a good organization, and a proven training allow reducing the consequences of a case of difficult intubation, scheduled or not. The new “videoscopic” devices seem to be superior to conventional intubation techniques, especially in case of difficult intubation. They will probably have a good position in the next guidelines for difficult intubation in emergency or, more generally, for emergency intubation. Each structure potentially facing emergency intubation should question her choice of material and its strategy.
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Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2015 dans la session : Support ventilatoire en urgence.
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Lapostolle, F., Galinski, M. & Adnet, F. Intubation en urgence. Réanimation 24 (Suppl 2), 413–419 (2015). https://doi.org/10.1007/s13546-015-1027-9
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DOI: https://doi.org/10.1007/s13546-015-1027-9