| Manejo de la situación no puedo intubar, no puedo ventilar |
INTRODUCTION Even when a patient proves to be unexpectedly difficult to intubate, it is usually not a problem to adequately oxygenate and ventilate the patient using bag-mask ventilation (BMV). Occasionally, and fortunately very rarely, we encounter a patient who is impossible to intubate AND who also cannot be adequately oxygenated. This is the feared 'can't intubate, can't ventilate' situation. The incidence of 'can't intubate, can't ventilate' in patients who are not expected to be difficult intubations is probably around 1 in 10 000 anesthetics. This condition obviously has life-threatening implications and must be resolved within minutes, if not seconds, to avoid hypoxic brain damage or death. http://update.anaesthesiologists.org/wp-content/uploads/2009/12/Cant-intubate-cant-ventilate.pdf |
| La formulación y la introducción de un algoritmo en la práctica clínica sobre "no se puede intubar, no se puede ventilar" |
The formulation and introduction of a 'can't intubate, can't ventilate' algorithm into clinical practice
A. M. B. Heard,1 R. J. Green2 and P. Eakins1
1 Consultant Anaesthetist, Royal Perth Hospital, Perth, Western Australia, Australia
2 Consultant Anaesthetist, Royal Bournemouth Hospital, Bournemouth, Dorset, UK
Anaesthesia, 2009, 64, pages 601-608
Summary Both the American Society of Anesthesiologists and the Difficult Airway Society of the United Kingdom have published guidelines for the managem ent of unanticipated difficult intubation. Both algorithms end with the 'can't intubate, can't ventilate' scenario. This eventuality is rare within elective anaesthetic practice with an estimated incidence of 0.01-2 in 10 000 cases, making the maintenance of skills and knowledge difficult. Over the last four years, the Department of Anaesthetics at the Royal Perth Hospital have developed a didactic airway training programme to ensure staff are appropriately trained to manage difficult and emergency airways. This article discusses our training programme, the evaluation of emergency airway techniques and subsequent development of a 'can't intubate, can't ventilate' algorithm. http://crashingpatient.com/wp-content/uploads/2011/07/heard-podcast-formulation-of-cicv-paradigm.pdf |
| Rescate de ventilación: resolviendo la situación no puedo intubar, no puedo ventilar durante el cambio de combitubo a un dispositivo de vía aérea definitivo |
Rescue Ventilation: Resolving a "Cannot Mask Ventilate, Cannot Intubate" Situation During Exchange of a Combitube for a Definitive Airway
James M. Rich, CRNA, MA, Andrew M. Mason, MB, BS, MRCS, LRCP, H.A. Tillmann Hein, MD, Michael Foreman, MD
AANA Journal October 2009, Vol. 77, No. 5
Our anesthesia care team was called to care for a patient who was admitted to the emergency department with the esophageal-tracheal double-lumen airway device (Combitube, Tyco Healthcare, Nellcor,Pleasanton, California) in place, which needed to be exchanged for a definitive airway because the patient required an extended period of mechanical ventilation. Several techniques were attempted to exchange the esophageal-tracheal Combitube (ETC) without success. First, we attempted direct laryngoscopy with the ETC in place after deflation of the No. 1 proximal cuff and sweeping the ETC to the left. We were prepared to use bougie-assisted intubation but could not identify any airway anatomy. After removal of the ETC, we
unsuccessfully attempted ventilation/intubation with a laryngeal mask airway (LMA Fastrach, LMA North America, San Diego, California). Our third attempt was insertion of another laryngeal mask airway (LMA Unique, LMA North America) with marginal ventilation, but we again experienced unsuccessful intubation using a fiberscope. The ETC was reinserted after each intubation attempt because mask ventilation was impossible. Before proceeding with cricothyrotomy, we repeated direct laryngoscopy but without the ETC in place. We identified the tip of the epiglottis, which allowed for bougie-assisted intubation. This obviated the need for
emergency cricothyrotomy.
Keywords: Airway exchange, Combitube, failed airway, failed intubation, rescue ventilation.
http://www.aana.com/newsandjournal/Documents/rescuevent_1009_p339-342.pdf |
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