MANAGEMENT OF PATIENTS WITH PREDICTED DIFFICULT AIRWAYS IN AN ACADEMIC EMERGENCY DEPARTMENT

被引:21
作者
Sakles, John C. [1 ]
Douglas, Matthew J. K. [1 ]
Hypes, Cameron D. [1 ,2 ]
Patanwala, Asad E. [3 ]
Mosier, Jarrod M. [1 ,2 ]
机构
[1] Univ Arizona, Coll Med, Dept Emergency Med, 1501 N Campbell Ave,POB 245057, Tucson, AZ 85724 USA
[2] Univ Arizona, Coll Med, Dept Med, Sect Pulm Crit Care Allergy & Sleep, Tucson, AZ USA
[3] Univ Arizona, Coll Med, Dept Pharm Practice & Sci, Tucson, AZ USA
关键词
difficult airway; airway management; tracheal intubation; intubation; video laryngoscopy; emergency department; VIDEO-LARYNGOSCOPY; SEQUENCE INTUBATION; SUCCESS;
D O I
10.1016/j.jemermed.2017.04.003
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Patients with difficult airways are sometimes encountered in the emergency department (ED), however, there is a little data available regarding their management. Objectives: To determine the incidence, management, and outcomes of patients with predicted difficult airways in the ED. Methods: Over the 1-year period from July 1, 2015 to June 30, 2016, data were prospectively collected on all patients intubated in an academic ED. After each intubation, the operator completed an airway management data form. Operators performed a pre-intubation difficult airway assessment and classified patients into routine, challenging, or difficult airways. All non-arrest patients were included in the study. Results: There were 456 patients that met inclusion criteria. Fifty (11%) had predicted difficult airways. In these 50 patients, neuromuscular blocking agents (NMBAs) were used in 40 (80%), an awake intubation technique with light sedation was used in 7 (14%), and no medications were used in 3 (6%). In the 40 difficult airway patients who underwent NMBA facilitated intubation, a video laryngoscope (GlideScope 21, Verathon, Bothell, WA and C-MAC 19, Karl Storz, Tuttlingen, Germany) was used in each of these, with a first-pass success of 90%. In the 7 patients who underwent awake intubation, a video laryngoscope was used in 5, and a flexible fiberoptic scope was used in 2. Ketamine was used in 6 of the awake in-tubations. None of these difficult airway patients required rescue with a surgical airway. Conclusions: Difficult airways were predicted in 11% of non-arrest patients requiring intubation in the ED, the majority of which were managed using an NMBA and a video laryngoscope with a high first-pass success. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:163 / 170
页数:8
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