Advanced Airway Interventions
March 25th, 2020
Bag-Valve-Mask
The bag-valve-mask system is a self-inflating device that is able to deliver high-flow oxygen, expiratory pressure and inspiratory pressure.
A bag-valve-mask system may be used with an oropharyngeal or nasopharyngeal airway in situ, to aid in opening the airway.
Intubation
If the patient requires intubation, this should be performed by a highly trained member of staff with appropriate planning, monitoring and pre-medication.
Indications for Intubation
Airway
- Inability to maintain airway patency (upper airway obstruction) - soft tissue swelling, deformity, obesity, tongue displacement
- Inability to protect the airway - sedation (e.g. for procedures), upper airway bleeding, excessive secretions
Breathing
- Inability to ventilate - unconsciousness, sedation, neuromuscular disease, exhaustion
- Inability to oxygenate - severe acute respiratory failure
Circulation
- Cardiac arrest
Complications of Intubation
During Insertion
- Incorrect placement - oesophagus / bronchus
- Trauma - teeth / oral cavity / pharynx / larynx / trachea
- Hypoxia (due to delayed intubation)
While Intubated
- Mechanical issues - tube obstruction / kinking, loss of cuff integrity
- Infection - ventilator-associated pneumonia
- Self extubation
After Extubation
- Sore throat
- Laryngeal / tracheal pathology - oedema, spasm, stenosis
- Vocal cord paralysis
Cricothyroidotomy
Cricothyroidotomy can be considered as an emergency airway technique in a patient with a difficult airway. This should be performed by an experienced operator with appropriate equipment and staff available.
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