Category: Critical Care Nursing Use of a tracheostomy tube can aid in weaning from mechanical ventilation, because the direct approach to the trachea (with an internal diameter greater than in the translaryngeal approach) and reduced length all reduce airflow resistance.
Category: Critical Care Nursing Tracheostomy offers many clinical benefits for patients with respiratory failure or individuals requiring prolonged mechanical ventilation or airway protection because of neurologic dysfunction.
Category: Critical Care Nursing During general anesthesia or after episodes of acute respiratory failure, patients are usually mechanically ventilated through an orotracheal tube, which can be easily and rapidly inserted as an initial airway device.
Category: Critical Care Nursing Resource management principles important for an efficient airway management team include explicit role assignments, closed loop communication and standardized guidelines for equipment, medication preparation and positioning.
Category: Critical Care Nursing Fourth National Audit Project (NAP4) found that preparation, equipment and communication errors were the most common causes of complications during airway management in ICUs and EDs in the United Kingdom.
Category: Critical Care Nursing Awake intubation provides the opportunity to preserve spontaneous respiration and prolong the time for intubation attempts. Upright fiber-optic–assisted intubation through a Williams or Ovassapian airway is a common and effective approach.
Category: Critical Care Nursing During a cricothyroidotomy, passing a bougie through the neck incision to serve as an ETT guide has been reported successful. Major complications include esophageal perforation, subcutaneous emphysema and bleeding.
Category: Critical Care Nursing Surgical cricothyroidotomy is reserved for the emergency airway situation when an extraglottic airway cannot be effectively employed because of upper airway abnormalities, blood or secretions that obviate proper placement and function.
Category: Critical Care Nursing Intubation through supraglottic device (SGDs) has proven successful after failed direct laryngoscopy. A number of SGDs provide one-step intubation through the device (Ambu Aura-i, Air-Q/ILA, LMA Fastrach and Classic Excel, i-Gel).
Category: Critical Care Nursing Intubating supraglottic devices (SGDs) are appropriate primary or rescue strategy devices. SGDs can be placed into the upper airway to reestablish adequate oxygenation and ventilation without significant technical expertise in many cases.
Category: Critical Care Nursing Most algorithms recommended a stepwise approach to difficult airway management, using tracheal intubation, face mask ventilation and supraglottic airway devices, followed by surgical airway if life-threatening situation exists.
Category: Critical Care Nursing In the setting of a predicted difficult airway management, indirect optical devices and videolaryngoscopy provide better glottic visualization and maximize the likelihood of intubation success.
Category: Critical Care Nursing A difficult airway is defined as the presence of clinical factors that complicate ventilation or intubation. The incidence of difficult airways encountered during emergent intubations is reported to be 10%.
Category: Critical Care Nursing Direct laryngoscopy failure is frequently associated with the inability to visualize the glottis, whereas failure in videolaryngoscopy is often related to the inability to pass the ETT. Each device has unique technical considerations.
Category: Critical Care Nursing Indirect laryngoscopy incorporates angulated blades (i.e., GlideScope, McGrath, C-MAC), whereas others incorporate a channel (i.e., Airtraq, Pentax) to facilitate ETT placement through a more anterior glottis with a neutral positioned head.
