Monday, May 7, 2018

Drowned Airway

PulmCrit (EMCrit)
PulmCrit - May 7, 2018 - By Josh Farkas

"Summary: The Bullet
  • The drowned airway is a rare and uniquely perilous situation were copious regurgitation prevents either intubation or mask ventilation. These patients are at very high risk of aspiration, ARDS, anoxic brain damage, or cardiac arrest.
  • Massive regurgitation may be prevented in some cases by using gastric ultrasonography to detect large volumes of gastric fluid. NG tube drainage before intubation may mitigate risk.
  • Front-line techniques for management of the drowned airway are large-bore catheter suctioning, Seldinger intubation using a large-bore suction catheter, or esophageal diversion with an endotracheal tube.
  • There should be a low threshold to perform surgical cricothyrotomy if other techniques fail or if the patient begins desaturating. Cricothyrotomy is highly effective, but in order to work it must be initiated early (before the patient develops massive aspiration or anoxic brain injury).
  • An airway algorithm is proposed for management of the drowned airway."