Dear airway enthusiastic friends,
Although there are many articles related to airway management in this time of COVID -19 era, my interested turned to a bit different choice to share with you- of course related to what I know best: Obese Airway management. It refers to not one but to two correspondences in BJA, related to airway trauma in critically ill obese patients due to COVID-19 .
1.Tracheal trauma after difficult airway management in morbidly obese patients with COVID-19
2.Tracheal introducers and airway trauma COVID-19.
As we face the new worldwide pandemic of COVID-19, it was clearly suggested that a serious potential risk factor for infection development with severe disease progression is obesity. Simonnet et al mentioned that approximately 85% of patients with obesity required mechanical ventilation and other preliminary data from New York City showed that obesity (BMI>40 kg/m2) is the second strongest independent predictor of hospitalization, after old age (preprint by Petrilli et al.)
The first paper exemplified that patients with severe obesity with a typical presentation of SARS-CoV-2 infection, requiring invasive ventilationafter failing noninvasive oxygen therapy presented difficult tracheal intubation and the use of a bougie probably induced tracheal trauma thereby worsening the respiratory condition and leading to urgent ECMO.
The second paper has come on behalf of the airway experts as a response to the first paper and give advice about the optimising oxygen delivery before intubation to allow more controlled airway management especially in hypoxaemic obese patients. The likelihood of successful tracheal bougie placement with a Grade IV laryngeal view is quite low, whereas the risk of airway trauma as a result of blind bougie insertion is significant, so that use of a bougie in such a scenario is considered contraindicated.
The appropriate use of this simple device remains a precious adjunct for airway management in conjunction with direct or video-laryngoscopy, especially in difficult airway management patients such as obese patients.
Hi, my dear airway enthusiastic friends.
A lot of papers run into my head to be selected for “article of the month”.
I finally decided to present you this one:
Tracheostomy in the COVID-19 era: global and multidisciplinary guidance
Three reasons directed me to this choice
- The interest of the topic in this COVID-19 pandemic. There have been published a lot of papers on tracheostomy in the COVID-19 patient by several scientific societies and working groups coming from different medical disciplines, mainly Head and Neck surgery, Critical Care, and Anaesthesiology. This paper tries to summarize all opinions.
- The multidiscipline and international composition of the group of authors (30), most of them known experts on the topic, coming from (in alphabetical order) Australia, China, France, Germany, Italy, Spain, Switzerland, UK and USA
-The accurate update of the paper (24 references from a total of 45 were published in 2020 and 2 more papers were “in press”)
There is an excellent summary of recommendations about patient selection, timing of tracheostomy, performance and management after procedure
I hope you enjoy this paper.
Dear EAMS members and airway enthusiasts,
July’s article of the month consists of a narrative review of the Front of Neck Access (FONA) from well renowned airway experts.
The management of a Cannot Intubate-Cannot Oxygenate (CI-CO) scenario is extremely challenging and one of the anaesthesiologist's fields of expertise. The authors mention that “the concept of FONA covers a large amount of techniques, principles, problems and debates”. The review discusses the epidemiological and technical aspects about CI-CO.
Although only a few will ever perform a cricothyrotomy during their careers, always remember the 7 Ps: Proper Planning, Preparation and Practise Prevents Poor Performance!
Enjoy this Summer reading in the EAMS Journal Trends in Anaesthesia and Critical Care!
Keep safe and well!
Ana Isabel Pereira
I hope you manage to stay well and healthy and are still able to get to some reading done in this crazy year. Flexible endoscopic intubation has been praised as the standard technique for expected difficult intubations by numerous international guidelines. Current literature suggests that this is an easy technique with a high success rate and low complication rate. However, having taught flexible endoscopic intubations at workshop skill stations throughout the world, I found that anesthesiologists' skills in this technique are often inadequate. There seems a significant disconnect between published literature and clinical reality.
In this month's manuscript, Dr. Grange et al. examined the experience with flexible intubation in the UK. They show what others already knew: one of the critical skills in anesthesiology is not as frequently used as it should be, the complication rate does not seem to match the published data.
Enjoy the read in the EAMS journal TACC!
Documents and Links
Consensus guidelines for managing the airway in patients with COVID-19
OUTBREAK OF A NEW CORONAVIRUS. WHAT ANAESTHETISTS SHOULD KNOW BJA 2020
THE ITALIAN CORONAVIRUS DISEASE 2019. OUTBREAK ANAESTHESIA 2020
March moth’s articles comes as a pair: Two 2020-papers (epub ahead of print 2019) that have to be read in conjunction: Ahmad and co-workers review on multiple aspects and practical guidance for AWAKE INTUBATION – The cornerstone technique in managing the predicted difficult airway, plus our accompanying editorial that reminds us that if an awake intubation is indicated then we shouldn’t abandon it easily – but remember that a spontaneous-ventilating intubation may be a close second best.
Michael Seltz Kristensen
Ahmad I, El-Boghdadly K, Bhagrath R, et al. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults [published online ahead of print, 2019.
Aziz MF, Kristensen MS. From variance to guidance for awake tracheal intubation [published online ahead of print, 2019.
The most stressful situation for an anaesthesiologist may be a No intubate/No oxigenate (NINO) patient. A recent study (NAP 4) says that in spite of the fact that all algorithms have a strategy for this situation- in all of them cricotirotomy is the final solution-, the resolution is not good in most of them. Why is this? How could we correct the mistakes that arise?. Simulation has proven to be an effective tool to improve how crisis resources are managed, such as NINO patient and CPR. It allows mistakes to be analyzed and solutions found, thus improving our performance. But, what if we have a NINO patient on whom we are performing cardiopulmonary resuscitation? This study by Ott et al (BMJ 2019) tries to address this question by establishing a possible airway management situation that, however infrequent, must not be forgotten. We hope you enjoy reading it.
Pedro Charco Mora
Ott T, Stracke J, Sellin S, et al. Impact of cardiopulmonary resuscitation on a cannot intubate, cannot oxygenate condition: a randomised crossover simulation research study of the interaction between two algorithms. BMJ Open 2019;9:e030430. doi:10.1136/bmjopen-2019-030430
Open acces link (january 23th, 2020): https://bmjopen.bmj.com/content/9/11/e030430.info
Dear airway enthusiasts,
This month’s article is a from Fiadjoe et al. about pediatric normal and difficult airway management. If you are curious about the following questions you have to read the full text:
- • What are cognitive biases observed in pediatric difficult airway management?
- • What are the strengths and weaknesses of videolaryngoscopes and flexible bronchoscopes for tracheal intubation?
- • What is the current evidence for spontaneous versus controlled ventilation techniques when managing the anticipated difficult airway?
- • What is the role of passive oxygenation in difficult airway management in the OR and pediatric ICU?
- • What is the current evidence regarding the use of neuromuscular blockade in neonatal tracheal intubation and difficult airway in children?
Have fun at http://eamshq.net
Kemal Tolga Saracoglu
Welcome letter from the new President, Michael Seltz Kristensen
Dear EAMS member! Dear co-airway-afficionado!
It is an honour to take over this position as President of EAMS!
The “European” in “European Airway Management Society” is not meant geographically!
It is meant to describe a European approach based on multiple inputs, discussion and best evidence, accepting different needs and resources, and based on human diversity.
Therefore, we are a true GLOBAL society, with members, You!, from all parts of the world.
Dear EAMS members
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