Vía aérea en situaciones críticas

Intubación traqueal en UCI: ¿Salva o amenaza vidas? Tracheal intubation in the ICU: Life saving or life threatening? Divatia JV, Khan PU, Myatra SN. Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India. Indian J Anaesth. 2011 Sep;55(5):470-5. Abstract Tracheal intubation (TI) is a routine procedure in the intensive care unit (ICU), and is often life saving. However, life-threatening complications occur in a significant proportion of procedures, making TI perhaps one the most common but underappreciated airway emergencies in the ICU. In contrast to the controlled conditions in the operating room (OR), the unstable physiologic state of critically ill patients along with underevaluation of the airways and suboptimal response to pre-oxygenation are the major factors for the high incidence of life-threatening complications like severe hypoxaemia and cardiovascular collapse in the ICU. Studies have shown that strategies planned for TI in the OR can be adapted and extrapolated for use in the ICU. Non-invasive positive-pressure ventilation for pre-oxygenation provides adequate oxygen stores during TI for patients with precarious respiratory pathology. The intubation procedure should include not only airway management but also haemodynamic, gas exchange and neurologic care, which are often crucial in critically ill patients. Hence, there is a necessity for the implementation of an Intubation Bundle during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237146/?tool=pubmed    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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