Airway Management for the Critically Ill Patient in the Emergency Department
Main Article Content
Abstract
Airway management is both a fundamental skill and resuscitative treatment that has taken a prominent role in emergency medicine. In the past few decades there have been many advancements in airway management particularly in critically ill patients. Technology has been developed and adapted to provide improved visualization for endotracheal intubation as well as supportive strategies for oxygenation and optimization of medications. In this review we will discuss the current practices and literature in airway management of critically ill patients including medication optimization and airway visualization techniques for first pass success.
Article Details
How to Cite
STAHL, Jennifer; O’DONNELL, John.
Airway Management for the Critically Ill Patient in the Emergency Department.
Medical Research Archives, [S.l.], v. 11, n. 4, apr. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3720>. Date accessed: 26 apr. 2024.
doi: https://doi.org/10.18103/mra.v11i4.3720.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Lentz S, Grossman A, Koyfman A, Long B. High-risk airway management in the emergency department. part I: Diseases and approaches. J Emerg Med. 2020;59(1):84-95. doi: 10.1016/j.jemermed.2020.05.008.
3. Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med. 1995;333(13):817-822. doi: 10.1056/NEJM199509283331301.
4. Masip J. Noninvasive ventilation in acute cardiogenic pulmonary edema. Curr Opin Crit Care. 2008;14(5):531-535. doi: 10.1097/MCC.0b013e32830c4862.
5. Xu X, Zhang X, Hu S, et al. Noninvasive ventilation in acute hypoxemic nonhypercapnic respiratory failure: A systematic review and meta-analysis. Crit Care Med. 2017;45(7):e727-e733. doi: 10.1097/CCM.0000000000002361.
6. Jaber S, Monnin M, Girard M, et al. Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: The single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med. 2016;42(12):1877-1887. doi: 10.1007/s00134-016-4588-9.
7. Groth CM, Acquisto NM, Khadem T. Current practices and safety of medication use during rapid sequence intubation. J Crit Care. 2018;45:65-70. doi: 10.1016/j.jcrc.2018.01.017.
8. Zeuchner J, Graf J, Elander L, Frisk J, Fredrikson M, Chew MS. Introduction of a rapid sequence induction checklist and its effect on compliance to guidelines and complications. Acta Anaesthesiol Scand. 2021;65(9):1205-1212. doi: 10.1111/aas.13947.
9. Bhat R, Mazer-Amirshahi M, Sun C, et al. Accuracy of rapid sequence intubation medication dosing in obese patients intubated in the ED. Am J Emerg Med. 2016;34(12):2423-2425. doi: 10.1016/j.ajem.2016.09.056.
10. Ferguson I, Milligan J, Buttfield A, et al. FentAnyl or placebo with KeTamine for emergency department rapid sequence intubation: The FAKT study protocol. Acta Anaesthesiol Scand. 2019;63(5):693-699. doi: 10.1111/aas.13309.
11. Frakes MA. Rapid sequence induction medications: An update. J Emerg Nurs. 2003;29(6):533-540. doi: 10.1016/j.jen.2003.08.005.
12. Tammen AJ, Brescia D, Jonas D, Hodges JL, Keith P. Fentanyl-induced rigid chest syndrome in critically ill patients. J Intensive Care Med. 2023;38(2):196-201. doi: 10.1177/08850666221115635.
13. Yoon SW, Choi GJ, Seong H, Lee MJ, Kang H. Pharmacological strategies to prevent haemodynamic changes after intubation in parturient women with hypertensive disorders of pregnancy: A network meta-analysis. Int J Med Sci. 2021;18(4):1039-1050. doi: 10.7150/ijms.54002.
14. Fulton B, Sorkin EM. Propofol. an overview of its pharmacology and a review of its clinical efficacy in intensive care sedation. Drugs. 1995;50(4):636-657. doi: 10.2165/00003495-199550040-00006.
15. Mace SE. Challenges and advances in intubation: Rapid sequence intubation. Emerg Med Clin North Am. 2008;26(4):1043-68, x. doi: 10.1016/j.emc.2008.10.002.
16. El Mourad MB, Shaaban AE, El Sharkawy SI, Afandy ME. Effects of propofol, dexmedetomidine, or ketofol on respiratory and hemodynamic profiles in cardiac patients undergoing transesophageal echocardiography: A prospective randomized study. J Cardiothorac Vasc Anesth. 2021;35(9):2743-2750. doi: 10.1053/j.jvca.2020.11.013.
17. Valk BI, Struys MMRF. Etomidate and its analogs: A review of pharmacokinetics and pharmacodynamics. Clin Pharmacokinet. 2021;60(10):1253-1269. doi: 10.1007/s40262-021-01038-6.
18. Vanlersberghe C, Camu F. Etomidate and other non-barbiturates. Handb Exp Pharmacol. 2008;(182):267-82. doi(182):267-282. doi: 10.1007/978-3-540-74806-9_13.
19. Simpson GD, Ross MJ, McKeown DW, Ray DC. Tracheal intubation in the critically ill: A multi-centre national study of practice and complications. Br J Anaesth. 2012;108(5):792-799. doi: 10.1093/bja/aer504.
20. Hampton JP, Hommer K, Musselman M, Bilhimer M. Rapid sequence intubation and the role of the emergency medicine pharmacist: 2022 update. Am J Health Syst Pharm. 2023;80(4):182-195. doi: 10.1093/ajhp/zxac326.
21. Sih K, Campbell SG, Tallon JM, Magee K, Zed PJ. Ketamine in adult emergency medicine: Controversies and recent advances. Ann Pharmacother. 2011;45(12):1525-1534. doi: 10.1345/aph.1Q370.
22. Zeiler FA, Teitelbaum J, West M, Gillman LM. The ketamine effect on intracranial pressure in nontraumatic neurological illness. J Crit Care. 2014;29(6):1096-1106. doi: 10.1016/j.jcrc.2014.05.024.
23. Smischney NJ, Nicholson WT, Brown DR, et al. Ketamine/propofol admixture vs etomidate for intubation in the critically ill: KEEP PACE randomized clinical trial. J Trauma Acute Care Surg. 2019;87(4):883-891. doi: 10.1097/TA.0000000000002448.
24. Okubo M, Gibo K, Hagiwara Y, Nakayama Y, Hasegawa K, Japanese Emergency Medicine Network Investigators. The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: An analysis of multicenter prospective observational study. Int J Emerg Med. 2017;10(1):1-8. Epub 2017 Jan 25. doi: 10.1186/s12245-017-0129-8.
25. Bozeman WP, Kleiner DM, Huggett V. A comparison of rapid-sequence intubation and etomidate-only intubation in the prehospital air medical setting. Prehosp Emerg Care. 2006;10(1):8-13. doi: 10.1080/10903120500366854.
26. Wilcox SR, Bittner EA, Elmer J, et al. Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications. Crit Care Med. 2012;40(6):1808-1813. doi: 10.1097/CCM.0b013e31824e0e67.
27. Li J, Murphy-Lavoie H, Bugas C, Martinez J, Preston C. Complications of emergency intubation with and without paralysis. Am J Emerg Med. 1999;17(2):141-143. doi: 10.1016/s0735-6757(99)90046-3.
28. McManus MC. Neuromuscular blockers in surgery and intensive care, part 2. Am J Health Syst Pharm. 2001;58(24):2381-2395. doi: 10.1093/ajhp/58.24.2381.
29. McManus MC. Neuromuscular blockers in surgery and intensive care, part 1. Am J Health Syst Pharm. 2001;58(23):2287-2299. doi: 10.1093/ajhp/58.23.2287.
30. Rosenberg H, Pollock N, Schiemann A, Bulger T, Stowell K. Malignant hyperthermia: A review. Orphanet J Rare Dis. 2015;10:93-1. doi: 10.1186/s13023-015-0310-1.
31. van den Bersselaar LR, Heytens L, Silva HCA, et al. European neuromuscular centre consensus statement on anaesthesia in patients with neuromuscular disorders. Eur J Neurol. 2022;29(12):3486-3507. doi: 10.1111/ene.15526.
32. Tran DTT, Newton EK, Mount VAH, Lee JS, Wells GA, Perry JJ. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2015;2015(10):CD002788. doi: 10.1002/14651858.CD002788.pub3.
33. Tran DTT, Newton EK, Mount VAH, et al. Rocuronium vs. succinylcholine for rapid sequence intubation: A cochrane systematic review. Anaesthesia. 2017;72(6):765-777. doi: 10.1111/anae.13903.
34. Shin J. Anesthetic management of the pregnant patient: Part 2. Anesth Prog. 2021;68(2):119-127. doi: 10.2344/anpr-68-02-12.
35. Mort TC. Emergency tracheal intubation: Complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99(2):607-13, table of contents. doi: 10.1213/01.ANE.0000122825.04923.15.
36. FRUMIN MJ, EPSTEIN RM, COHEN G. Apneic oxygenation in man. Anesthesiology. 1959;20:789-798. doi: 10.1097/00000542-195911000-00007.
37. Semler MW, Janz DR, Lentz RJ, et al. Randomized trial of apneic oxygenation during endotracheal intubation of the critically ill. Am J Respir Crit Care Med. 2016;193(3):273-280. doi: 10.1164/rccm.201507-1294OC.
38. Corl KA, Dado C, Agarwal A, et al. A modified montpellier protocol for intubating intensive care unit patients is associated with an increase in first-pass intubation success and fewer complications. J Crit Care. 2018;44:191-195. doi: 10.1016/j.jcrc.2017.11.014.
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