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Airway Management - State of Art

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 15012

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Prof. Dr. Jacek Smereka

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Guest Editor

Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
Interests: critical care; emergency medicine; anesthesiology; cardiopulmonary resuscitation

Special Issue Information

Dear Colleagues,

Airway management and the mechanical ventilation of patients are the cornerstones of intensive care, including intensive therapy, emergency medicine, emergency medical services, and cardiopulmonary resuscitation. In recent years, there has been great progress in airway management. On the one hand, new equipment is available to help with difficult airway management in both elective and emergency situations and, on the other hand, emergency procedures are increasingly being adapted for medical personnel with limited clinical experience. Research in the field of emergency airway management indicates the usefulness of new equipment and clinical practice techniques. The increasing number of scientific papers on rescue ventilation and airway management necessitates the revision of current methods of management and recommendations for prehospital and hospital medical providers. While airway management in the operating theatre by experienced anesthesiologists has become the standard practice, with advanced equipment and highly experienced clinical staff, airway management in prehospital and emergency departments requires further studies. This Special Issue of the Journal of Clinical Medicine is dedicated to airway management, the evaluation of hospital and prehospital procedures, and emergency ventilation and its impact on complications and patient survival.

It is hoped that the readers will find this topic important from a practical point of view, as well as the authors, who will present the results of their clinical trials evaluating various methods of airway management, the use of modern equipment, and the implementation of equipment routinely used in operating theatres into clinical practice in emergency departments and prehospital settings. Another topic is the management of emergency ventilation and ways to optimize ventilation to ensure the patient's safety in severe respiratory failure. The COVID-19 pandemic has demonstrated the importance of providing mechanical ventilation and ventilatory support to patients with severe respiratory failure, not only in intensive care units but also in the prehospital setting and in hospital wards where such critically ill patients are not routinely treated.

Prof. Dr. Jacek Smereka
Guest Editor

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Keywords

airway management
direct laryngoscopy
video-laryngoscopy
endotracheal tube
supraglottic airway devices
ventilation

Published Papers (6 papers)

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Research

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19 pages, 2294 KiB

Open AccessArticle

Airway Management of Patients with Suspected or Confirmed COVID-19: Survey Results from Physicians from 19 Countries in Latin America

by Manuel Granell, Nerea Sanchis, Carlos Delgado, Manuel Lozano, Marcio Pinho, Cecilia Sandoval, Carolina S. Romero, Cesar Aldecoa, Juan P. Cata, Jorge Neira, Jose De Andres, Alejandro Herreros-Pomares, Guillermo Navarro and The COV2-VIAEREA Network Study Group

J. Clin. Med. 2022, 11(16), 4731; https://doi.org/10.3390/jcm11164731 - 12 Aug 2022

Cited by 2 | Viewed by 2210

Abstract

Airway management during the COVID-19 pandemic has been one of the most challenging aspects of care that anesthesiologists and intensivists face. This study was conducted to evaluate the management of tracheal intubation in patients with suspected or confirmed COVID-19 infection. This is a cross-sectional and international multicenter study based on a 37-item questionnaire. The survey was available to physicians who had performed intubations and tracheostomies in patients with suspected or confirmed COVID-19 and had provided informed consent to participate. The primary outcome is the preference to use a specific device for tracheal intubation. Secondary outcomes are clinical practice variables, use of video laryngoscopes, difficult airway management, and safety features to prevent cross-infection. This study included 2411 physicians who performed an average of 11.90 and 20.67 tracheal intubations in patients diagnosed or suspected of having COVID-19 disease, respectively. Physicians were mainly from the specialties of Anesthesiology (61.2%) and Intensive Care (7.4%). COVID-19 infection diagnosed by positive PCR or serology in physicians participating in intubation in this study was 15.1%. Respondents considered preoxygenation for more than three minutes very useful (75.7%). The preferred device for tracheal intubation was the video laryngoscope (64.8%). However, the direct laryngoscope (57.9%) was the most commonly used, followed by the video laryngoscope (37.5%). The preferred device to facilitate intubation was the Eschmann guide (34.2%). Percutaneous tracheostomy was the preferred technique (39.5%) over the open tracheostomy (22%). The predicted or unpredicted difficult airway management in these patients was preferably performed with a video laryngoscope (61.7% or 63.7, respectively). Intubation was mostly performed by two or more expert airway physicians (61.6%). The use of personal protective equipment increased the practitioners’ discomfort during intubation maneuvers. The video laryngoscope is the preferred device for intubating patients with COVID-19, combined with the Eschmann guide, flexible stylet within the endotracheal tube, or Frova guide to facilitate intubation. The sub-analysis of the two groups of physicians by the level of intubation experience showed a higher use of the video laryngoscope (63.4%) in the experts group and no significant differences between the two groups in terms of cross-infection rates in physicians, in their preference for the use of the video laryngoscope or in the number of intubations performed in confirmed or suspected COVID-19 patients. Full article

(This article belongs to the Special Issue Airway Management - State of Art)

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9 pages, 1897 KiB

Open AccessArticle

Association between Successful Palpation of the Cricothyroid Membrane and the 3-3-2 Rule for Predicting Difficult Airway in Female Patients Undergoing Non-Neck Surgery: A Prospective Observational Cohort Study

by So Yeon Lee, Da Kyung Hong, Chang Jae Kim, Mee Young Chung, Sanghoon Lee and Min Suk Chae

J. Clin. Med. 2022, 11(9), 2316; https://doi.org/10.3390/jcm11092316 - 21 Apr 2022

Cited by 1 | Viewed by 3056

Abstract

Background: Prediction of difficult airway is important for airway management in patients undergoing surgery. The assessment of airway structures and establishment of protective airway strategies are essential to improve patient safety. However, the association between successful palpation of the cricothyroid membrane and airway predictions has not been fully elucidated in patients undergoing surgery. We investigated this in female patients undergoing non-neck surgery. Methods: A total of 68 female patients were enrolled in this prospective observational cohort study between January 2021 and June 2021 at Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea. Exclusion criteria were male patients and those with neck pathology or neck surgery. The assessment of difficult airway was performed before the induction of anesthesia and was defined by one of the following conditions: inter-incisor distance < 3 fingerbreadths, hyoid-to-mental distance < 3 fingerbreadths, and thyroid-to-hyoid distance < 2 fingerbreadths (the “3-3-2 rule”). The accuracy of palpable identification of the cricothyroid membrane was confirmed by ultrasonography (US). The patients were divided into the non-difficult airway (NDA) group (n = 30) and the difficult airway (DA) group (n = 30). Results: The two groups were comparable in terms of age, but the DA group had higher body mass index (BMI). In airway assessment, 9 patients showed inter-incisor distance < 3 fingerbreadths, 3 patients showed hyoid-to-mental distance < 3 fingerbreadths, and 24 patients showed thyroid-to-hyoid distance < 2 fingerbreadths in the DA group. The rate of successful palpation of the cricothyroid membrane was higher in the patients without than in those with difficult airway variables. Conclusions: Patients with a positive 3-3-2 rule showed a poor palpability of cricothyroid membrane. Full article

(This article belongs to the Special Issue Airway Management - State of Art)

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8 pages, 934 KiB

Open AccessArticle

Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro

by Tzu-Pei Wang, Hsin-Hsien Li and Hui-Ling Lin

J. Clin. Med. 2022, 11(2), 307; https://doi.org/10.3390/jcm11020307 - 08 Jan 2022

Cited by 2 | Viewed by 1895

Abstract

Accumulated secretion above the endotracheal tube cuff can be aspirated during extubation after deflation. The possible techniques for minimizing pulmonary aspiration from subglottic secretion during extubation have not been well explored. This study aimed to determine the effect of different extubation techniques on secretion leakage. An endotracheal tube was placed in a tube mimicking an airway. We measured the leak volume of water or artificial sputum of different viscosities with three extubation techniques—negative pressure with suctioning; positive pressure with a resuscitator; and continuous positive airway pressure set at 5, 10, and 20 cm H₂O. Extubation with continuous positive airway pressure resulted in lower secretion leakage than that with negative pressure with suctioning and positive pressure with a resuscitator. Increasing the continuous positive airway pressure level decreased secretion leakage volume during extubation. We further determined a correlation of leak volume with sputum viscosity. Continuous positive airway pressure at 5 cm H₂O produced lower volume secretion leakage than the other two techniques, even with higher secretion viscosity. Based on these results, using continuous positive airway pressure with a previous ventilator continuous positive airway pressure/positive end-expiratory pressure setting for extubation is recommended. Full article

(This article belongs to the Special Issue Airway Management - State of Art)

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10 pages, 1266 KiB

Open AccessArticle

Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial

by Leszek Gadek, Lukasz Szarpak, Lars Konge, Marek Dabrowski, Dominika Telecka-Gadek, Maciej Maslanka, Wiktoria Laura Drela, Marta Jachowicz, Lukasz Iskrzycki, Szymon Bialka, Frank William Peacock and Jacek Smereka

J. Clin. Med. 2021, 10(24), 5740; https://doi.org/10.3390/jcm10245740 - 08 Dec 2021

Cited by 8 | Viewed by 2902

Abstract

A safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support algorithm for suspected or confirmed COVID-19 patients. The aim of this study was to compare intubation success rates (ISR) and intubation time (IT) of different laryngoscopes for simulated COVID-19 patients under cardiopulmonary resuscitation. The study was designed as a prospective, randomized, crossover trial. Fifty four active paramedics performed endotracheal intubation with a Macintosh direct laryngoscope (MAC) and McGrath videolaryngoscope (McGrath) with and without personal protective equipment (PPE). Without PPE, ISRs were 87% and 98% for MAC and McGrath, respectively (p = 0.32). ITs were 22.5 s (IQR: 19–26) and 19.5 s (IQR: 17–21) for MAC and McGrath, respectively (p = 0.005). With PPE, first-pass ISR were 30% and 89% with MAC and McGrath, respectively (p < 0.001). The overall success rates were 83% vs. 100% (p = 0.002). Median ITs were 34.0 s (IQR: 29.5–38.5) and 24.8 s (IQR: 21–29) for MAC and McGrath, respectively (p < 0.001). In conclusion, the McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios. Full article

(This article belongs to the Special Issue Airway Management - State of Art)

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12 pages, 1427 KiB

Open AccessArticle

Efficacy and Safety of Video-Laryngoscopy versus Direct Laryngoscopy for Double-Lumen Endotracheal Intubation: A Systematic Review and Meta-Analysis

by Katarzyna Karczewska, Szymon Bialka, Jacek Smereka, Maciej Cyran, Grazyna Nowak-Starz, Jaroslaw Chmielewski, Michal Pruc, Pawel Wieczorek, Frank William Peacock, Jerzy Robert Ladny and Lukasz Szarpak

J. Clin. Med. 2021, 10(23), 5524; https://doi.org/10.3390/jcm10235524 - 25 Nov 2021

Cited by 10 | Viewed by 2175

Abstract

The available meta-analyses have inconclusively indicated the advantages of video-laryngoscopy (VL) in different clinical situations; therefore, we conducted a systematic review and meta-analysis to determine efficacy outcomes such as successful first attempt or time to perform endotracheal intubation as well as adverse events of VL vs. direct laryngoscopes (DL) for double-lumen intubation. First intubation attempt success rate was 87.9% for VL and 84.5% for DL (OR = 1.64; 95% CI: 0.95 to 2.86; I² = 61%; p = 0.08). Overall success rate was 99.8% for VL and 98.8% for DL, respectively (OR = 3.89; 95%CI: 0.95 to 15.93; I² = 0; p = 0.06). Intubation time for VL was 43.4 ± 30.4 s compared to 54.0 ± 56.3 s for DL (MD = −11.87; 95%CI: −17.06 to −6.68; I² = 99%; p < 0.001). Glottic view based on Cormack–Lehane grades 1 or 2 equaled 93.1% and 88.1% in the VL and DL groups, respectively (OR = 3.33; 95% CI: 1.18 to 9.41; I² = 63%; p = 0.02). External laryngeal manipulation was needed in 18.4% cases of VL compared with 42.8% for DL (OR = 0.28; 95% CI: 0.20 to 0.40; I² = 69%; p < 0.001). For double-lumen intubation, VL offers shorter intubation time, better glottic view based on Cormack–Lehane grade, and a lower need for ELM, but comparable first intubation attempt success rate and overall intubation success rate compared with DL. Full article

(This article belongs to the Special Issue Airway Management - State of Art)

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Other

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26 pages, 6043 KiB

Open AccessSystematic Review

Should We Use High-Flow Nasal Cannula in Patients Receiving Gastrointestinal Endoscopies? Critical Appraisals through Updated Meta-Analyses with Multiple Methodologies and Depiction of Certainty of Evidence

by Chi Chan Lee, Teressa Reanne Ju, Pei Chun Lai, Hsin-Ti Lin and Yen Ta Huang

J. Clin. Med. 2022, 11(13), 3860; https://doi.org/10.3390/jcm11133860 - 03 Jul 2022

Cited by 3 | Viewed by 1868

Abstract

(1) Background: High-flow nasal cannula (HFNC) therapy or conventional oxygen therapy (COT) are typically applied during gastrointestinal (GI) endoscopic sedation. (2) Methods: We conducted a rigorous systematic review enrolling randomized controlled trials (RCTs) from five databases. Risk of bias was assessed using Cochrane’s RoB 2.0 tool; certainty of evidence (CoE) was assessed using GRADE framework. Meta-analysis was conducted using inverse-variance heterogeneity model and presented as relative risk (RR) with 95% confidence interval (CI). Trial sequential analysis was performed, and sensitivity analysis was conducted with Bayesian approach. (3) Results: Eight RCTs were included. Compared to COT, HFNC did not reduce the overall incidence of hypoxemia (RR 0.51; 95% CI 0.24–1.09; CoE: very low) but might reduce the incidence of hypoxemia in patients at moderate to high risk for hypoxemia (RR 0.54; 95% CI 0.31–0.96; and CoE: very low). HFNC might reduce the incidence of severe hypoxemia (RR 0.38; 95% CI 0.20–0.74; and CoE: low). HFNC might not affect the need of minor airway interventions (RR 0.31; 95% CI 0.08–1.22; and CoE: very low) and had no effect on procedure duration (CoE: very low); (4) Conclusions: During GI endoscopic sedation, HFNC might reduce the incidence of hypoxemia in patients at moderate to high risk for hypoxemia and prevent severe hypoxemia. Full article

(This article belongs to the Special Issue Airway Management - State of Art)

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