Guidelines for the management of tracheal intubation in critically ill adults
Guidelines for the management of tracheal intubation in critically ill adults
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DOI：
10.1016/j.bja.2017.10.021
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发表时间：
2018-02-01
影响因子：
9.8
通讯作者：
Cook, T. M.
中科院分区：
文献类型：
--
作者：
Higgs, A.;McGrath, B. A.;Cook, T. M.
这些指南描述了一个全面的策略，以优化氧合，气道管理，气管插管危重病人，在所有医院的位置。它们是对皇家麻醉师学院和困难气道协会第四次国家审计项目的直接回应，该项目强调了对这些极其脆弱的患者的管理不足，导致重大并发症和可避免的死亡。它们建立在现有的强有力证据基础上，在没有证据的情况下由专家共识补充。这些指南认识到，改善紧急气道管理的结果需要更加关注人为因素，而不是简单地引入新设备或提高技术熟练度。他们强调气道团队的作用，在整个气道管理过程中共享的心理模型，计划和沟通。强调了氧合的首要性，包括预氧合和过氧合。建议采用改良快速测序法。最佳管理是在一个算法，结合计划B和C，纳入涡流方法的元素。为了避免延迟和任务固定，限制程序尝试，及时识别失败，并过渡到下一个算法步骤的重要性被强调。该指南建议早期使用视频喉镜，屏幕对所有人都可见，并使用第二代声门上气道进行气道救援。对于紧急颈前气道的建议是手术刀-探条-插管技术，同时承认由训练有素的专家进行的其他技术的价值。由于大多数重症监护气道灾难发生在插管后，从移位或堵塞的管道，避免这些并发症的基本方法也强调。
These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not. These guidelines recognize that improved outcomes of emergency airway management require closer attention to human factors, rather than simply introduction of new devices or improved technical proficiency. They stress the role of the airway team, a shared mental model, planning, and communication throughout airway management. The primacy of oxygenation including pre- and peroxygenation is emphasized. A modified rapid sequence approach is recommended. Optimal management is presented in an algorithm that combines Plans B and C, incorporating elements of the Vortex approach. To avoid delays and task fixation, the importance of limiting procedural attempts, promptly recognizing failure, and transitioning to the next algorithm step are emphasized. The guidelines recommend early use of a videolaryngoscope, with a screen visible to all, and second generation supraglottic airways for airway rescue. Recommendations for emergency front of neck airway are for a scalpel-bougie-tube technique while acknowledging the value of other techniques performed by trained experts. As most critical care airway catastrophes occur after intubation, from dislodged or blocked tubes, essential methods to avoid these complications are also emphasized.