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Airway Management
 
 

Advanced Airway Interventions

 
 
 
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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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