sábado, 9 de noviembre de 2013

Vía aérea prehospitalaria/Prehospital airway

Uso del tubo laríngeo en para cardiaco fuera del hospital por paramédicos noruegos 
Laryngeal tube use in out-of-hospital cardiac arrest by paramedics in Norway.
Sunde GA, Brattebø G, Odegården T, Kjernlie DF, Rødne E, Heltne JK.
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway. geir.arne.sunde@helse-bergen.no
Scand J Trauma Resusc Emerg Med. 2012 Dec 18;20:84. doi: 10.1186/1757-7241-20-84.

Determinación prehospitalaria de la colocación del tubo traqueal en daño grave de cabeza
Prehospital determination of tracheal tube placement in severe head injury.
Grmec S, Mally S.
Emergency Medical Service, Prehospital Unit, Maribor, Slovenia.
Emerg Med J. 2004 Jul;21(4):518-20.
OBJECTIVES: The aim of this prospective study in the prehospital setting was to compare three different methods for immediate confirmation of tubeplacement into the trachea in patients with severe head injury: auscultation, capnometry, and capnography. METHODS: All adult patients (>18 years) with severe head injury, maxillofacial injury with need of protection of airway, or polytrauma were intubated by an emergency physician in the field. Tube position was initially evaluated by auscultation. Then, capnometry and capnography was performed (infrared method). Emergency physicians evaluated capnogram and partial pressure of end tidal carbon dioxide (EtCO(2)) in millimetres of mercury.Determination of final tube placement was performed by a second direct visualisation with laryngoscope. Data are mean (SD) and percentages. RESULTS: There were 81 patients enrolled in this study (58 with severe head injury, 6 with maxillofacial trauma, and 17 politraumatised patients). At the first attempt eight patients were intubated into the oesophagus. Afterwards endotracheal intubation was undertaken in all without complications. The initial capnometry (sensitivity 100%, specificity 100%), capnometry after sixth breath (sensitivity 100%, specificity 100%), and capnography after sixth breath (sensitivity 100%, specificity 100%) were significantly better indicators for tracheal tube placement than auscultation (sensitivity 94%, specificity 66%, p<0.01). CONCLUSION: Auscultation alone is not a reliable method to confirm endotracheal tube placement in severely traumatised patients in the prehospitalsetting. It is necessary to combine auscultation with other methods like capnometry or capnography.
Manejo de vía aérea en trauma maxilofacial. Estudio retrospectivo de 177 casos  
Airway management in patients with maxillofacial trauma - A retrospective study of 177 cases.
Raval CB, Rashiduddin M.
Department of Anesthesia, Al-Nahdha Hospital, Muscat, Oman.
Saudi J Anaesth. 2011 Jan;5(1):9-14. doi: 10.4103/1658-354X.76476.
BACKGROUND: Airway management in maxillofacial injuries presents with a unique set of problems. Compromised airway is still a challenge to the anesthesiologist in spite of all modalities available. Maxillofacial injuries are the result of high-velocity trauma arising from road traffic accidents, sport injuries, falls and gunshot wounds. Any flaw in airway management may lead to grave morbidity and mortality in prehospital or hospital settings and as well as for reconstruction of fractures subsequently. METHODS: One hundred and seventy-seven patients of maxillofacial injuries, operated over a period of one and half years during July 2008 to December 2009 in Al-Nahdha hospital were reviewed. All patients were reviewed in depth with age related type of injury, etiology and techniques of difficult airway management. RESULTS: The major etiology of injuries were road traffic accidents (67%) followed by sport (15%) and fall (15%). Majority of patients were young in the age group of 11-30 years (71 %). Fracture mandible (53%) was the most common injury, followed by fracture maxilla (21%), fracture zygoma (19%) and pan-facial fractures (6%). Maxillofacial injuries compromise mask ventilation and difficult airway due to facial fractures, tissue edema and deranged anatomy. Shared airway with the surgeon needs special attention due to restrictions imposed during surgery. Several methods available for securing the airway, both decision-making and performance, are important in such circumstances. Airway secured by nasal intubation with direct visualization of vocal cords was the most common (57%), followed by oral intubation (17%). Other methods like tracheostomy and blind nasal intubation was avoided by fiberoptic bronchoscopic nasal intubation in 26% of patients. CONCLUSION:The results of this study indicated that surgically securing the airway by tracheostomy should be revised compared to other available methods. In the era of rigid fixation of fractures and the possibility of leaving the patient without wiring an open mouth and alternative techniques like fiberoptic bronchoscopic intubation, it is unnecessary to carry out tracheostomy for securing the airway as frequently as in the past.
KEYWORDS: Difficult airway, fiberoptic bronchoscopic intubation, maxillofacial injuries, tracheostomy

Anestesiología y Medicina del Dolor

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