Otro poco sobre la vía aérea

Efecto de las compresiones torácicas sobre el tiempo necesario para colocar dispositivos en la vía aérea en un manikí Effect of chest compressions on the time taken to insert airway devices in a manikin. Gatward JJ, Thomas MJ, Nolan JP, Cook TM. Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG, UK. jongatward@hotmail.com Br J Anaesth. 2008 Mar;100(3):351-6. Epub 2007 Dec 24. Abstract BACKGROUND: Resuscitation guidelines recommend that chest compressions should continue throughout attempts to place airway devices. Few data support the use of the tracheal tube over supraglottic airway devices (SADs) during cardiopulmonary arrest. This study was designed to evaluate the speed with which different airway devices could be placed with and without interrupting chest compressions. METHODS: Forty volunteer doctors regularly involved in cardiopulmonary resuscitation (CPR) were timed inserting four different airway devices [tracheal tube (TT), LMA Classic (cLMA), LMA ProSeal (PLMA), and igel] into a manikin, with and without stopping chest compressions. RESULTS: Chest compressions delayed the placement of the TT only (3.3 s, P<0.0001). Comparison of the speed of insertion of the different airway devices during CPR enabled ranking of the devices: igel (fastest), PLMA (second), and TT and cLMA (joint slowest). The igel was inserted approximately 50% faster than the other devices. Doctors who had previously inserted more than 50 tracheal tubes were significantly faster at intubating the trachea, but no faster at inserting SADs. CONCLUSIONS: Our results show that continuing chest compressions has a minor effect on time for tracheal intubation and until clear human data are available the recommendation to intubate without interrupting CPR is therefore justified. The PLMA and igel (SADs with a gastric drain tube) were both faster to insert than the cLMA and offer additional benefits. They should be considered for use in CPR. http://bja.oxfordjournals.org/content/100/3/351.full.pdf+html    Traqueostomía: ¿Por qué, cuando y como? Tracheostomy: why, when, and how? Durbin CG Jr. Department of Anesthesiology, University of Virginia, Box 800710, Charlottesville, VA 22908, USA. cgd8v@virginia.edu Respir Care. 2010 Aug;55(8):1056-68. Abstract Tracheostomy is one of the most frequent procedures performed in intensive care unit (ICU) patients. Of the many purported advantages of tracheostomy, only patient comfort, early movement from the ICU, and shorter ICU and hospital stay have significant supporting data. Even the belief of increased safety with tracheostomy may not be correct. Various techniques for tracheostomy have been developed; however, use of percutaneous dilation techniques with bronchoscopic control continue to expand in popularity throughout the world. Tracheostomy should occur as soon as the need for prolonged intubation (longer than 14 d) is identified. Accurate prediction of this duration by day 3 remains elusive. Mortality is not worse with tracheotomy and may be improved with earlier provision, especially in head-injured and critically ill medical patients. The timing of when to perform a tracheostomy continues to be individualized, should include daily weaning assessment, and can generally be made within 7 days of intubation. Bedside techniques are safe and efficient, allowing timely tracheostomy with low morbidity. http://www.rcjournal.com/contents/08.10/08.10.1056.pdf Trauma mayor de las vías aéreas, manejo y resultados a largo tiempo  Major airways trauma, management and long term results. Farzanegan R, Alijanipour P, Akbarshahi H, Abbasidezfouli A, Pejhan S, Daneshvar A, Behgam MS. Tracheal Diseases Research Center, National Research Institute of Tuberculosis & Lung Diseases, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences and Health Services, Tehran, Iran. Ann Thorac Cardiovasc Surg. 2011;17(6):544-51. Epub 2011 Aug 17. Abstract PURPOSE: The number of patients with traumatic and iatrogenic tracheobronchial injuries is increasing. Early diagnosis, prompt establishment of a secure airway, and appropriate management could prevent sequelae and lead to a good outcome. METHODS: Between "1994-2007", 35 patients with major airways trauma were managed. This descriptive and retrospective study evaluates clinical findings, diagnostic approaches, initial managements, definitive surgical or nonsurgical treatments and follow-up results. SPSS was used for descriptive outcomes. RESULTS: There were 27 males (77%) and 8 females, with a mean age of 28.2. There were 16 blunt, 11 penetrating and 8 iatrogenic traumas, at the level of the larynx in 1, larynx and hypopharynx in 3, laryngotracheal in 12, tracheal in 13, tracheobronchial in 1, and main bronchi in 5 patients. Fourteen patients (40%) were initially managed, and 21 patients were referred to us after their initial managements at outside hospitals. There were 7 complications (20%); one resulted in mortality (2.9%). The overall final results were good in 57.1%, acceptable in 31.4% and poor in 5.7% of patients, (mean follow-up time, 58.2 months). The respiratory status and the phonation looked better in the initially managed than the delayed managed group. CONCLUSION: We recommend that, patients only become respiratory stable with minimum intervention and then be referred to centers with sufficient experience in airway surgery. http://www.jstage.jst.go.jp/article/atcs/17/6/544/_pdf

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