生理困难气道在急诊气道管理中的风险及管理策略

doi:10.3969/j.issn.1004-583X.2023.09.016

摘要/Abstract

摘要：

生理困难气道是指从开始气管插管至过渡到正压通气期间,患者的生理变化会增加心肺及其他并发症的风险。低血压、低氧血症、代谢性酸中毒及右心功能障碍等生理紊乱因素,显著增加了围插管期发生低血压和心力衰竭的风险。生理困难气道在急诊重症患者中尤为明显,但也可发生在生理紊乱的健康人中,如肥胖者、妊娠期和儿童。了解生理困难气道患者的生理变化和风险,对优化生理紊乱和采取相关措施避免气管插管并发症尤为重要。本文回顾临床上常见的生理性困难气道,并根据现有证据对其的管理策略进行综述。

关键词: 插管法, 气管内, 气道管理, 困难气道, 生理紊乱

中图分类号:

R472.9

占秀文, 梁璐, 王斌. 生理困难气道在急诊气道管理中的风险及管理策略[J]. 临床荟萃, 2023, 38(9): 859-864.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.09.016

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I9/859

参考文献 45

[1]	Heidegger T. Management of the difficult airway[J]. N Engl J Med, 2021, 384(19):1836-1847. doi: 10.1056/NEJMra1916801 URL
[2]	Russotto V, Myatra SN, Laffey JG, et al. Intubation practices and adverse peri-intubation events in critically Ill patients from 29 countries[J]. JAMA, 2021, 325(12):1164. doi: 10.1001/jama.2021.1727 pmid: 33755076
[3]	Mosier JM, Joshi R, Hypes C, et al. The physiologically difficult airway[J]. West J Emerg Med, 2015, 16(7):1109-1117. doi: 10.5811/westjem.2015.8.27467 pmid: 26759664
[4]	Capone J, Gluncic V, Lukic A, et al. Physiologically difficult airway in the patient with severe hypotension and metabolic acidosis[J]. Case Rep Anesthesiol, 2020, 4(2020):8821827.
[5]	Karamchandani K, Wheelwright J, Yang AL, et al. Emergency airway management outside the operating room: Current evidence and management strategies[J]. Anesth Analg, 2021, 133(3):648-662. doi: 10.1213/ANE.0000000000005644 pmid: 34153007
[6]	Cai S, Sandhu M, Gruenbaum S, et al. Airway management in an anatomically and physiologically difficult airway[J]. Cureus, 2020, 12(9):e10638.
[7]	Owyang CG. Evaluation and management of the physiologically difficult airway: Consensus recommendations from society for airway management[J]. Anesth Analg, 2021, 132(2):395-405. doi: 10.1213/ANE.0000000000005233 pmid: 33060492
[8]	Russotto V, Myatra SN, Laffey JG. What's new in airway management of the critically ill[J]. Int J Crit Illn Inj Sci, 2019, 45(11):1615-1618.
[9]	Myatra SN, Divatia JV, Brewster DJ. The physiologically difficult airway: An emerging concept[J]. Curr Opin Anaesthesiol, 2022, 35(2):115-121. doi: 10.1097/ACO.0000000000001102 pmid: 35165233
[10]	Mosier JM, Joshi R, Hypes C. The physiologically difficult airway[J]. West J Emerg Med, 2015, 16(7):1109-1117. doi: 10.5811/westjem.2015.8.27467 pmid: 26759664
[11]	Natt BS, Malo J, Hypes CD, et al. Strategies to improve first attempt success at intubation in critically ill patients[J]. Br J Anaesth, 2016, 117(Suppl 1):i60-i68.
[12]	Mosier JM, Sakles JC, Law JA, et al. Tracheal intubation in the critically ill. where we came from and where we should go[J]. Am J Respir Crit Care Med, 2020, 201(7):775-788. doi: 10.1164/rccm.201908-1636CI URL
[13]	Brindley PG, Beed M, Law JA, et al. Airway management outside the operating room: How to better prepare[J]. Can J Anaesth, 2017, 64(5):530-539. doi: 10.1007/s12630-017-0834-z pmid: 28168630
[14]	Heffner AC, Swords DS, Nussbaum ML, et al. Predictors of the complication of postintubation hypotension during emergency airway management[J]. J Crit Care, 2012, 27(6):587-593. doi: 10.1016/j.jcrc.2012.04.022 pmid: 22762924
[15]	Funk DJ, Jacobsohn E, Kumar A. The role of venous return in critical illness and shock-part I: Physiology[J]. Crit Care Med, 2013, 41(1):255-262. doi: 10.1097/CCM.0b013e3182772ab6 URL
[16]	de Witt B, Joshi R, Meislin H, et al. Optimizing oxygen delivery in the critically ill: Assessment of volume responsiveness in the septic patient[J]. J Emerg Med, 2014, 47(5):608-615. doi: 10.1016/j.jemermed.2014.06.015 pmid: 25088530
[17]	Scott JA, Heard SO, Zayaruzny M. Airway management in critical illness[J]. Chest, 2007, 131(2):608-620. doi: 10.1378/chest.06-2120 pmid: 17296669
[18]	Clifford RG. Pathophysiology of right ventricular failure[J]. Crit Care Med, 2008, 36(Suppl):57-65.
[19]	Grignola JC, Enric D. Acute right ventricular dysfunction in intensive care unit[J]. Biomed Res Int, 2017, 2017:1-15.
[20]	Hockstein MA, Haycock K, Wiepking M, et al. Transthoracic right heart echocardiography for the intensivist[J]. J Intensive Care Med, 2021, 36(9):1098-1109. doi: 10.1177/08850666211003475 URL
[21]	Krishnan S, Schmidt GA. Acute right ventricular dysfunction: Real-time management with echocardiography[J]. Chest, 2015, 147(3):835-846. doi: S0012-3692(15)39682-3 pmid: 25732449
[22]	Naeije R. Pulmonary vascular resistance. a meaningless variable?[J]. Intensive Care Med, 2003, 29(4):526-529. doi: 10.1007/s00134-003-1693-3 URL
[23]	Sakles JC, Pacheco GS, Kovacs G, et al. The difficult airway refocused[J]. Br J Anaesth, 2020, 125(1):e18-e21.
[24]	Patanwala AE, Erstad BL, Roe DJ, et al. Succinylcholine is associated with increased mortality when used for rapid sequence intubation of severely brain injured patients in the emergency department[J]Pharmacotherapy, 2016, 36(1):57-63. doi: 10.1002/phar.1683 URL
[25]	刘加明, 苏俊红. 危重病患者低氧血症的临床分析[J]. 临床荟萃, 1998, 13(17):796-797.
[26]	Cook TM, Woodall N, Frerk C, et al. Major complications of airway management in the uk: Results of the fourth national audit project of the royal college of anaesthetists and the difficult airway society. part 1: Anaesthesia - sciencedirect[J]. Br J Anaesth, 2011, 106(5):617-631. doi: 10.1093/bja/aer058 pmid: 21447488
[27]	Myatra SN, Shah A, Kundra P, et al. All india difficult airway association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults[J]. Indian J Anaesth, 2016, 60(12):885-898. doi: 10.4103/0019-5049.195481 pmid: 28003690
[28]	Frerk C, Mitchell VS, Mcnarry AF, et al. Difficult airway society 2015 guidelines for management of unanticipated difficult intubation in adults[J]. Br J Anaesth, 2015(6):827-848. doi: 10.1093/bja/aev371 pmid: 26556848
[29]	Kamming D, Patel A. Emergency anaesthetic strategies for the bleeding upper airway[J]. Hosp Med, 2005, 66(4):250-251. pmid: 15889881
[30]	Kristensen MS, Mcguire B. Managing and securing the bleeding upper airway: A narrative reviewLa prise en charge et la protection des voies aériennes supérieures lors de saignements: Un compte rendu narratif[J]. Can J Anaesth, 2019, 67(Suppl 1):128-140. doi: 10.1007/s12630-019-01479-5
[31]	Yendamuri S. Massive airway hemorrhage[J]. Thorac Surg Clin, 2015, 25(3):255-260. doi: 10.1016/j.thorsurg.2015.04.009 pmid: 26210922
[32]	Krishnan P, Todd DC, Mark S. Altered respiratory physiology in obesity[J]. Can Respir J, 2006, 13(4):203-210. doi: 10.1155/2006/834786 pmid: 16779465
[33]	高玉叶, 徐海, 孙妍. 肥胖对呼吸功能的影响及机制[J]. 临床荟萃, 2023, 38(4):381-384.
[34]	Seet E, Nagappa M, Wong DT. Airway Management in Surgical Patients With Obstructive Sleep Apnea[J]. Anesth Analg, 2021, 132(5):1321-1327. doi: 10.1213/ANE.0000000000005298 pmid: 33857974
[35]	Quinn AC, Milne D, Columb M, et al. Failed tracheal intubation in obstetric anaesthesia: 2 yr national case-control study in the UK[J]. Br J Anaesth, 2013(1):74-80. doi: 10.1093/bja/aes320 pmid: 22986421
[36]	Munnur U, Boisblanc BD, Suresh MS. Iconography: Airway problems in pregnancy[J]. Critical Care Clinics, 2005, 33(Supplement):S259-S268.
[37]	Izci B, Riha RL, Martin SE, et al. The upper airway in pregnancy and pre-eclampsia[J]. Am J Respir Crit Care Med, 2003, 167(2):137-140. doi: 10.1164/rccm.200206-590OC URL
[38]	Harless J, Ramaiah R, Bhananker SM. Pediatric airway management[J]. Emerg Med Clin North Am, 2014, 4(1):65-70.
[39]	Huang AS, Hajduk J, Rim C, et al. Focused review on management of the difficult paediatric airway[J]. Indian J Anaesth, 2019, 63(6):428-436. doi: 10.4103/ija.IJA_250_19 pmid: 31263293
[40]	Fiadjoe J, Nishisaki A. Normal and difficult airways in children: “What's New”—current evidence[J]. Paediatr Anaesth, 2020, 30(3):257-263. doi: 10.1111/pan.13798 pmid: 31869488
[41]	Vukovic AA, Hanson HR, Murphy SL, et al. Apneic oxygenation reduces hypoxemia during endotracheal intubation in the pediatric emergency department[J]. m J Emerg Med, 2019, 37(1):27-32.
[42]	Silva L, Cabrera D, Barrionuevo P, et al. effectiveness of apneic oxygenation during intubation: A systematic review and meta-analysis[J]. Ann Emerg Med, 2017, 70(4):483-494, e11. doi: S0196-0644(17)30582-6 pmid: 28712606
[43]	Rinderknecht AS, Mittiga MR, Meinzen-Derr J, et al. Factors associated with oxyhemoglobin desaturation during rapid sequence intubation in a pediatric emergency department: findings from multi variable analyses of video review data[J]. Acad Emerg Med, 2015, 22(4):431-440. doi: 10.1111/acem.12633 pmid: 25779855
[44]	Neuhaus D, Schmitz A, Gerber A, et al. Controlled rapid sequence induction and intubation-an analysis of 1001 children[J]. Paediatr Anaesth, 2013, 23(8):734-740. doi: 10.1111/pan.12213 pmid: 23763293
[45]	Miller KA, Goldman MP, Nagler J. Management of the Difficult Airway[J]. Br J Hosp Med (Lond), 2019, 80(8):432-440. doi: 10.12968/hmed.2019.80.8.432 URL

生理困难气道在急诊气道管理中的风险及管理策略

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 45

相关文章 1

编辑推荐

Metrics

本文评价