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Airway Management in Trauma

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Abstract

Etiology of trauma can be road traffic accident (RTA), fires, burns, falls, acts of violence and crimes. World over, road traffic accident is the eighth leading cause of death across all age groups. 1.35 million deaths have been attributed to road accidents in 2016. Airway management is required in patients with trauma for multiple indications, elective and emergency. Inappropriate or inadequate management of airway is an important contributory factor to morbidity and mortality. High quality airway care can make a significant difference between life and death and between good and poor outcome after trauma.

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References

  1. Who.int. 2021. https://www.who.int/. Accessed 10 Mar 2021.

  2. Rotondo M, Mcgonigal M, Schwab C, Kauder D, Hanson C. Urgent paralysis and intubation of trauma patients. Surv Anesthesiol. 1994;38(03):138.

    Article  Google Scholar 

  3. Talucci RC, Shaikh KA, Schwab CW. Rapid sequence induction with oral endotracheal intubation in the multiply injured patient. Am Surg. 1988;54(4):185–7. PMID: 3355013.

    CAS  PubMed  Google Scholar 

  4. Advanced trauma life support for doctors. Student course manual. Airway and ventilatory management. 10th ed. Chicago: American College of Surgeons Committee on Trauma; 2018. p. 24–40.

    Google Scholar 

  5. Khan RM, Sharma PK, Kaul N. Airway management in trauma. Indian J Anesth. 2011;55:463–9.

    Article  Google Scholar 

  6. Bair A, Caravelli R, Tyler K, Laurin E. Feasibility of the preoperative mallampati airway assessment in emergency department patients. J Emerg Med. 2010;38(5):677–80.

    Article  PubMed  Google Scholar 

  7. Reed M, Rennie L, Dunn M, Gray A, Robertson C, McKeown D. Is the ‘LEMON’ method an easily applied emergency airway assessment tool? Eur J Emerg Med. 2004;11(3):154–7.

    Article  PubMed  Google Scholar 

  8. Kovacs G, Sowers N. Airway management in trauma. Emerg Med Clin North Am. 2018;36(1):61–84.

    Article  PubMed  Google Scholar 

  9. Hauswald M, Sklar DP, Tandberg D, Garcia JF. Cervical spine movement during airway management: cinefluoroscopic appraisal in human cadavers. Am J Emerg Med. 1991;9(6):535–8.

    Article  CAS  PubMed  Google Scholar 

  10. Brimacombe J, Keller C, Kunzel KH, et al. Cervical spine motion during airway management: a cinefluoroscopic study of the posteriorly destabilized third cervical vertebrae in human cadavers. Anesth Analg. 2000;91:1274–8.

    Article  CAS  PubMed  Google Scholar 

  11. Cranshaw J, Nolan J. Airway management after major trauma. CEACCP. 2006;6(3):124–7.

    Google Scholar 

  12. Stephens CT, Kahntroff S, Dutton RP. The success of emergency endotracheal intubation in trauma patients: a 10-year experience at a major adult trauma referral center. Anesth Analg. 2009;109(3):866–72.

    Article  PubMed  Google Scholar 

  13. Lennarson PJ, Smith DW, Sawin PD, Todd MM, Sato Y, Traynelis VC. Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability. J Neurosurg. 2001;94(2 Suppl):265–70.

    CAS  PubMed  Google Scholar 

  14. Salem MR, Khorasani A, Zeidan A, Crystal GJ. Cricoid pressure controversies: narrative review. Anesthesiology. 2017;126(4):738–52.

    Article  PubMed  Google Scholar 

  15. Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99(2):607–13.

    Article  PubMed  Google Scholar 

  16. Sut EY, Gunal S, Yazar MA, Dikmen B. Comparison of effectiveness of intubation by way of “gum elastic bougie” and “intubating laryngeal mask airway” in endotracheal intubation of patients with simulated cervical trauma. Rev Bras Anestesiol. 2017;67(3):238–45.

    Article  PubMed  Google Scholar 

  17. Noguchi T, Koga K, Shiga Y, Shigematsu A. The gum elastic bougie eases tracheal intubation while applying cricoid pressure compared to a stylet. Can J Anesth. 2003;50(7):712–7.

    Article  PubMed  Google Scholar 

  18. McGill J. Airway management in trauma: an update. Emerg Med Clin North Am. 2007;25(3):603–22. Erratum in: Emerg Med Clin North Am. 2007 Nov;25(4), vii. https://doi.org/10.1016/j.emc.2007.06.007.

    Article  PubMed  Google Scholar 

  19. Malik MA, Maharaj CH, Harte BH, Laffey JG. Comparison of macintosh, truview EVO2, glidescope, and airwayscope laryngoscope use in patients with cervical spine immobilization. Br J Anesth. 2008;101(5):723–30.

    Article  CAS  Google Scholar 

  20. Suppan L, Tramèr MR, Niquille M, Grosgurin O, Marti C. Alternative intubation techniques vs. macintosh laryngoscopy in patients with cervical spine immobilization: systematic review and meta-analysis of randomized controlled trials. Br J Anesth. 2016;116(1):27–36.

    Article  CAS  Google Scholar 

  21. Mlinek EJ Jr, Clinton JE, Plummer D, Ruiz E. Fiberoptic intubation in the emergency department. Ann Emerg Med. 1990;19(4):359–62.

    Article  PubMed  Google Scholar 

  22. Keller C. Pressure exerted against the cervical vertebrae by the standard and intubating laryngeal mask airways: a randomized, controlled, cross-over study in fresh cadavers. Anesth Analg. 1999;89:1296–300.

    Article  CAS  PubMed  Google Scholar 

  23. Chou H, Tseng W, Wang C, Ma M, Wang H, Huang P, et al. Tracheal rapid ultrasound exam (T.R.U.E.) for confirming endotracheal tube placement during emergency intubation. Resuscitation. 2011;82(10):1279–84.

    Article  PubMed  Google Scholar 

  24. Brown CA 3rd, Bair AE, Pallin DJ, Walls RM, NEAR III Investigators. Techniques, success, and adverse events of emergency department adult intubations. Ann Emerg Med. 2015;65(4):363–70.

    Article  PubMed  Google Scholar 

  25. Sakles JC, Laurin EG, Rantapaa AA, Panacek EA. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998;31(3):325–32.

    Article  CAS  PubMed  Google Scholar 

  26. Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation. 2013;84(11):1500–4.

    Article  PubMed  Google Scholar 

  27. McCallion T, Richard M. Levitan F, Catherine A. Marco M, Elizabeth M. Phillips F, Now A, Joseph Scofi F et al. Resuscitation Archives—Page 2 of 3—ACEP Now [Internet]. ACEP Now. 2021. https://www.acepnow.com/tag/resuscitation/page/2/.

  28. Warner KJ, Cuschieri J, Jurkovich GJ, Bulger EM. Single-dose etomidate for rapid sequence intubation may impact outcome after severe injury. J Trauma. 2009;67(1):45–50.

    CAS  PubMed  Google Scholar 

  29. Hildreth AN, Mejia VA, Maxwell RA, Smith PW, Dart BW, Barker DE. Adrenal suppression following a single dose of etomidate for rapid sequence induction: a prospective randomized study. J Trauma. 2008;65(3):573–9.

    CAS  PubMed  Google Scholar 

  30. Upchurch C, Grijalva C, Russ S, Collins S, Semler M, Rice T, et al. Comparison of etomidate and ketamine for induction during rapid sequence intubation of adult trauma patients. Ann Emerg Med. 2017;69(1):24–33.e2.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wang X, Ding X, Tong Y, Zong J, Zhao X, Ren H, et al. Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials. J Anesth. 2014;28(6):821–7.

    Article  PubMed  Google Scholar 

  32. Himmelseher S, Durieux M. Revising a dogma: ketamine for patients with neurological injury? Anesth Analg. 2005;101(2):524–34.

    Article  CAS  PubMed  Google Scholar 

  33. Fields A, Rosbolt M, Cohn S. Induction agents for intubation of the trauma patient. J Trauma. 2009;67(4):867–9.

    PubMed  Google Scholar 

  34. Pinaud M, Lelausque J, Chetanneau A, Fauchoux N, Ménégalli D, Souron R. Effects of propofol on cerebral hemodynamics and metabolism in patients with brain trauma. Anesthesiology. 1990;73(3):404–9.

    Article  CAS  PubMed  Google Scholar 

  35. Weingart S. Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department. J Emerg Med. 2011;40(6):661–7.

    Article  PubMed  Google Scholar 

  36. Weingart S, Levitan R. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59(3):165–175.e1.

    Article  PubMed  Google Scholar 

  37. Merelman A, Perlmutter M, Strayer R. Alternatives to rapid sequence intubation: contemporary airway management with ketamine. West J Emerg Med. 2019;20(3):466–71.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Weingart S, Trueger N, Wong N, Scofi J, Singh N, Rudolph S. Delayed sequence intubation: a prospective observational study. Ann Emerg Med. 2015;65(4):349–55.

    Article  PubMed  Google Scholar 

  39. Silva OJEL, Cabrera D, Barrionuevo P, Johnson R, Erwin P, Murad M, et al. Effectiveness of apneic oxygenation during intubation: a systematic review and meta-analysis. Ann Emerg Med. 2017;70(4):483–494.e11.

    Article  Google Scholar 

  40. Binks M, Holyoak R, Melhuish T, Vlok R, Bond E, White L. Apneic oxygenation during intubation in the emergency department and during retrieval: a systematic review and meta-analysis. Am J Emerg Med. 2017;35(10):1542–6.

    Article  PubMed  Google Scholar 

  41. Lyons C, Callaghan M. Uses and mechanisms of apneic oxygenation: a narrative review. Anesthesia. 2019;74(4):497–507.

    Article  CAS  Google Scholar 

  42. Wong D, Yee A, Leong S, Chung F. The effectiveness of apneic oxygenation during tracheal intubation in various clinical settings: a narrative review. Can J Anesth. 2017;64(4):416–27.

    Article  PubMed  Google Scholar 

  43. Möller W, Feng S, Domanski U, Franke K, Celik G, Bartenstein P, et al. Nasal high flow reduces dead space. J Appl Physiol. 2017;122(1):191–7.

    Article  PubMed  Google Scholar 

  44. Chanques G, Riboulet F, Molinari N, Carr J, Jung B, Prades A, Galia F, Futier E, Constantin JM, Jaber S. Comparison of three high flow oxygen therapy delivery devices: a clinical physiological cross-over study. Minerva Anestesiol. 2013;79(12):1344–55.

    CAS  PubMed  Google Scholar 

  45. Salim R, Rezaie M, Camilo Mohar D, Yasmany Cartaya M, Andy LD. NO DESAT! | emergency physicians monthly [Internet]. Emergency Physicians Monthly | EPM 2021. https://epmonthly.com/article/no-desat/. Accessed 11 Mar 2021.

  46. Patel A, Nouraei S. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE): a physiological method of increasing apnea time in patients with difficult airways. Anesthesia. 2015;70(3):323–9.

    Article  CAS  Google Scholar 

  47. Crosby E, Warltier D. Airway management in adults after cervical spine trauma. Anesthesiology. 2006;104(6):1293–318.

    Article  PubMed  Google Scholar 

  48. Krishnamoorthy V, Dagal A, Austin N. Airway management in cervical spine injury. Int J Crit Illn Inj Sci. 2014;4(1):50.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Heath K. The effect on laryngoscopy of different cervical spine immobilization techniques. Anesthesia. 1994;49(10):843–5.

    Article  CAS  Google Scholar 

  50. Majernick T, Bieniek R, Houston J, Hughes H. Cervical spine movement during orotracheal intubation. Ann Emerg Med. 1986;15(4):417–20.

    Article  CAS  PubMed  Google Scholar 

  51. Goutcher C, Lochhead V. Reduction in mouth opening with semi-rigid cervical collars presented as a poster at the difficult airway society annual scientific meeting, Leicester, UK, November 25–26, 2004. Br J Anaesth. 2005;95(3):344–8.

    Article  CAS  PubMed  Google Scholar 

  52. Gerling M, Davis D, Hamilton R, Morris G, Vilke G, Garfin S, et al. Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation. Ann Emerg Med. 2000;36(4):293–300.

    Article  CAS  PubMed  Google Scholar 

  53. Aziz M. Use of video-assisted intubation devices in the management of patients with trauma. Anesthesiol Clin. 2013;31(1):157–66.

    Article  PubMed  Google Scholar 

  54. Aleksandrowicz D, Gaszyński T. Airway management with cervical spine immobilisation: a comparison between the macintosh laryngoscope, truview Evo2, and totaltrack VLM used by novices—a manikin study. Biomed Res Int. 2016;2016:1–5.

    Article  Google Scholar 

  55. Prokakis C, Koletsis E, Dedeilias P, Fligou F, Filos K, Dougenis D. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg. 2014;9(1):117.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Jain U, McCunn M, Smith C, Pittet J. Management of the traumatized airway. Anesthesiology. 2016;124(1):199–206.

    Article  PubMed  Google Scholar 

  57. Mercer S, Jones C, Bridge M, Clitheroe E, Morton B, Groom P. Systematic review of the anesthetic management of non-iatrogenic acute adult airway trauma. Br J Anaesth. 2016;117:i49–59.

    Article  PubMed  Google Scholar 

  58. Barak M, Bahouth H, Leiser Y, Abu E-NI. Airway management of the patient with maxillofacial trauma: review of the literature and suggested clinical approach. Biomed Res Int. 2015;2015:1–9.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, India

    S. Darshini & S. Vyshnavi

  2. Department of Anaesthesiology, Jerudong Park Medical Centre, Jerudong Park, Brunei Darussalam

    Raveendra Shankaranarayana Ubaradka

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  1. S. Darshini
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  2. S. Vyshnavi
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  3. Raveendra Shankaranarayana Ubaradka
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Editor information

Editors and Affiliations

  1. Department of Anaesthesiology, Jerudong Park Medical Centre, Jerudong Park, Brunei Darussalam

    Raveendra Shankaranarayana Ubaradka

  2. Department of Anesthesiology (BRA-IRCH), All India Institute of Medical Sciences, New Delhi, Delhi, India

    Nishkarsh Gupta

  3. Division of Neuroanesthesiology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, Pondicherry, India

    Prasanna Udupi Bidkar

  4. Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

    Debendra Kumar Tripathy

  5. Department of Anaesthesia Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Anju Gupta

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Darshini, S., Vyshnavi, S., Ubaradka, R.S. (2023). Airway Management in Trauma. In: Ubaradka, R.S., Gupta, N., Bidkar, P.U., Tripathy, D.K., Gupta, A. (eds) The Airway Manual. Springer, Singapore. https://doi.org/10.1007/978-981-19-4747-6_29

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  • DOI: https://doi.org/10.1007/978-981-19-4747-6_29

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