Vía aérea en UCI

Revisión clínica: manejo de vía aérea difícil Clinical review: management of difficult airways. Langeron O, Amour J, Vivien B, Aubrun F. Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. olivier.langeron@psl.aphp.fr Crit Care. 2006;10(6):243. Abstract Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainly at induction of anesthesia. Nevertheless, claim reports emphasize that airway emergencies, tracheal extubation and/or recovery of anesthesia phases are still associated with death or brain damage, indicating that additional educational support and management strategies to improve patient safety are required. The present brief review analyses specific problems of airway management related to difficult tracheal intubation and to difficult mask ventilation prediction. The review will focus on basic airway management including preoxygenation, and on some oxygenation and tracheal intubation techniques that may be performed to solve a difficult airway. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1794480/pdf/cc5112.pdf Manejo de la vía aérea en enfermedades graves Airway management in critical illness. Walz JM, Zayaruzny M, Heard SO. Department of Anesthesiology, Division of Critical Care Medicine, UMass Memorial Medical Center, 55 Lake Ave North, Worcester MA 01655, USA.mwalz1@msn.com Chest. 2007 Feb;131(2):608-20. Abstract Airway management in the ICU can be complicated due to many factors including the limited physiologic reserve of the patient. As a consequence, the likelihood of difficult mask ventilation and intubation increases. The incidence of failed airways and of cardiac arrest related to airway instrumentation in the ICU is much higher than that of elective intubations performed in the operating room. A thorough working knowledge of the devices available for the management of the difficult airway and recommended rescue strategies is paramount in avoiding bad patient outcomes. In this review, we will provide a conceptual framework for airway assessment, with an emphasis on assessment of the patient with limited cervical spine movement or injury and of morbidly obese patients. Furthermore, we will review the devices that are available for airway management in the ICU, and discuss controversies surrounding interventions like cricoid pressure and the use of muscle relaxants in the critically ill patient. Finally, strategies for the safe extubation of patients with known difficult airways will be provided. http://chestjournal.chestpubs.org/content/131/2/608.full.pdf+html

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