Manual of Airway Management in Critical Care

 

Your instant access VST eBook offers 22 videos on functional anatomy, applied ultrasound, patient positioning, insertion and removal techniques, airway management of the surgical patient, and special considerations and techniques for the pediatric patient. The eBook also contains zoomable images and additional clinical cases to further the reader's understanding of clinical variability.Patterned after the renowned Walls Manual of Emergency Airway Management, Manual of Airway Management in Critical Care is a concise, focused reference on this challenging topic specifically for ICU providers. Drs. Jarrod M. Mosier, Calvin A. Brown III, Matteo Parotto, and Raquel R. Bartz bring their extensive expertise in critical care airway management to this all-new volume, as well as Dr. Mosier’s experience as director of the nationally recognized The Difficult Airway Course: Critical Care™. An excellent resource for intensivists, advanced practice providers, critical care nurses, and respiratory therapists, this first-of-its-kind text reflects ICU airway management from cover to cover: its unique standards of care, its unique risks, and its unique body of literature that set it apart from other medical disciplines.

 

Table of Contents:

 

Video Contents

SECTION I: Principles of Airway Management

1 Why Airway Management Matters

INTRODUCTION

CHAPTER 2 Functional Airway Anatomy

INTRODUCTION

THE NOSE

IMPORTANT ANATOMICAL CONSIDERATIONS

The Mouth

The Pharynx

The Larynx

Trachea

SUMMARY

CHAPTER 3 The Decision to Intubate

INTRODUCTION

INDICATIONS FOR INTUBATION

APPROACH TO THE PATIENT

ACKNOWLEDGMENT

CHAPTER 4 The Difficult Airway

INTRODUCTION

SECTION II: Developing a Strategy

5 Airway Evaluation for Anatomic Difficulty

INTRODUCTION

The Difficult Airway

Difficult Laryngoscopy: LEMON

Difficult BMV: ROMAN

Difficult EGD: RODS

Difficult Cricothyrotomy: SMART

ACKNOWLEDGMENT

CHAPTER 6 The Physiologically Difficult Airway: Hemodynamics

DEFINITION OF THE PHYSIOLOGICALLY DIFFICULT AIRWAY

HEMODYNAMICS

STEPWISE HEMODYNAMIC APPROACH

Who Should Be Intubated Awake?

CHAPTER 7 The Physiologically Difficult Airway: Hypoxemia

INTRODUCTION: SAFE APNEA

PREOXYGENATION

Denitrogenation

Functional Residual Capacity

V/Q Mismatch

REFRACTORY HYPOXEMIA

EVIDENCE

CHAPTER 8 The Physiologically Difficult Airway: Metabolic Acidosis, Induction Drugs, and Positive Pressure Ventilation

INTRODUCTION

EFFECT OF METABOLIC ACIDOSIS

EFFECT OF INDUCTION AGENTS

HEMODYNAMIC EFFECTS OF POSITIVE PRESSURE VENTILATION

Venous Return

Right Ventricular Function

Left Ventricular Function

CHAPTER 9 Developing Your Strategy

INTRODUCTION

THE STRATEGY FRAMEWORK

PICKING A PATH

Case 1: No Predicted Difficulty (Fig. 9.3)

Case 2: Predicted Difficulty With Intubation, But Not Mask Ventilation or Rescue Oxygenation (Fig. 9.4)

Case 3: Predicted Difficulty With Intubation and Mask Ventilation, But Rescue Oxygenation Is not Predicted to Be Difficult (Fig. 9.5)

Case 4: All Predicted to Be Difficult (Fig. 9.6)

Case 5: Forced to RSI (Fig. 9.7)

Case 6: The Cardiac Arrest Airway (Fig. 9.8)

MODIFY THE STRATEGY BASED ON THE PHYSIOLOGICALLY DIFFICULT AIRWAY CHARACTERISTICS

Case 7: Sepsis and ARDS (Fig. 9.9)

Case 8: Refractory Hypoxemia (Fig. 9.10)

CHAPTER 10 Applied Airway Ultrasound

INTRODUCTION

UPPER AIRWAY ANATOMY

Image Acquisition and Structure Identification

IDENTIFICATION OF THE CRICOTHYROID MEMBRANE

EVALUATION FOR LARYNGEAL EDEMA PRIOR TO EXTUBATION

Image Acquisition and Interpretation

CHAPTER 11 Applied Ultrasonography

INTRODUCTION

GASTRIC ULTRASONOGRAPHY

PULMONARY ULTRASONOGRAPHY

ECHOCARDIOGRAPHY

Workflow ( Video 11.2): Parasternal Long Axis

Parasternal Short Axis (PSAX)

Apical 4 and 5 Chamber (A4C, A5C)

Subxiphoid

SUMMARY

SECTION III: Applied Airway Pharmacology

12 Options

INTRODUCTION

RAPID SEQUENCE INTUBATION

SPONTANEOUSLY BREATHING INTUBATION (AWAKE INTUBATION)

DELAYED SEQUENCE INTUBATION

CHAPTER 13 Sedative Agents for Rapid Sequence Intubation

INTRODUCTION

ETOMIDATE

Clinical Pharmacology

Indications and Contraindications

Dosage and Clinical Use

Adverse Effects

KETAMINE

Clinical Pharmacology

Indications and Contraindications

Dosage and Clinical Use

Adverse Effects

PROPOFOL

Clinical Pharmacology

Indications and Contraindications

Dosage and Clinical Use

Additional Adverse Effects

MIDAZOLAM

Clinical Pharmacology

Indications and Contraindications

Dosage and Clinical Use

Adverse Effects

ALTERNATIVE AGENTS

SUMMARY

CHAPTER 14 Neuromuscular Blocking Agents

INTRODUCTION

SUCCINYLCHOLINE

Clinical Pharmacology

Indications and Contraindications

Dosage and Clinical Use

Adverse Effects

COMPETITIVE NEUROMUSCULAR BLOCKING AGENTS

Clinical Pharmacology

Indications

Dosage and Clinical Use

Contraindications and Adverse Effects

Reversal of Nondepolarizing Agents

Decision Making Between Depolarizing and Nondepolarizing Agents

SUMMARY

CHAPTER 15 Vasoactive Agents

INTRODUCTION

VASOPRESSORS

Phenylephrine

Vasopressin

Angiotensin II

INOPRESSORS

Norepinephrine

Epinephrine

Dopamine

INODILATORS

Dobutamine

Milrinone

Isoproterenol

INHALED PULMONARY VASODILATORS

Inhaled Epoprostenol

Inhaled Nitric Oxide

Inhaled Nitroglycerin

Inhaled Milrinone

KEY CLINICAL CONSIDERATIONS

Hypotension and Shock

RV Failure

Pulmonary Hypertension

Neurologically Injured Patient

Tachydysrhythmias

Massive PE

SUMMARY

CHAPTER 16 Topical Anesthetics and Anesthesia for Awake Intubation

INTRODUCTION

TOPICALIZATION OF THE OROPHARYNX, HYPOPHARYNX, AND GLOTTIC STRUCTURES

Variations

TOPICALIZATION OF THE NASOPHARYNX

Topicalization Technique

LIDOCAINE TOXICITY RISK

SEDATION

ACKNOWLEDGMENT

SECTION IV: Preparing the Patient

17 Preoxygenation and Apneic Oxygenation

INTRODUCTION

PRINCIPLES OF PREOXYGENATION

OXYGEN DELIVERY DEVICES

Noninvasive Positive Pressure Ventilation for Preoxygenation

High-Flow Nasal Oxygen

Nonrebreather Mask

Bag-Valve Mask

DEVICES NOT RECOMMENDED FOR PREOXYGENATION

Standard Nasal Cannulas

Simple Face Mask

Venturi Mask

OTHER PREOXYGENATION CONCEPTS

Monitoring the Effectiveness of Preoxygenation Using End-Tidal Oxygen

Concept of Delayed Sequence Intubation to Facilitate Preoxygenation

Apneic Oxygenation

Bagging During the Apneic Period

Rescue Oxygenation

SUMMARY

CHAPTER 18 Physiologic Optimization

INTRODUCTION

MONITORING

PRACTICAL APPROACH TO PHYSIOLOGIC OPTIMIZATION

Optimization by Organ System

Cardiovascular

Postintubation Optimization

MECHANICAL VENTILATION

Postintubation Sedation

SUMMARY

CHAPTER 19 Positioning

INTRODUCTION

POSITIONING FOR PREOXYGENATION

POSITIONING FOR INTUBATION

Fully Upright Position

OPERATOR POSITIONING

POSITIONING FOR CRICOTHYROTOMY

SPECIAL PATIENT POPULATIONS

Obesity

Pregnancy

SUMMARY

SECTION V: Navigating the Airway

20 Maximizing First-Attempt Success

INTRODUCTION

KEYS TO OPTIMIZING FIRST-ATTEMPT INTUBATION SUCCESS AND SAFETY

Use a Standardized Approach to Intubation

The Importance of Neuromuscular Blockade for Tracheal Intubation

Importance of a Preintubation Checklist

Optimal Preoxygenation Is Critical

Make the First Attempt the Best Attempt

A Simple Algorithm Is Invaluable When Intubation Attempts Fail

Backups Need to Be Available, Well-Proven, and Well-Practiced

Calling for Help

Taking Ownership, Continuous Quality Improvement, and the Airway Lead

SUMMARY

CHAPTER 21 Bag-Mask Ventilation

INTRODUCTION

BAG-VALVE-MASK DEVICES

OPTIMAL FACE MASK VENTILATION TECHNIQUE ( Video 21.1)

Optimizing Face Mask Seal

Face Mask Grip for Maximal Mandibular Advancement (Jaw Thrust)

Neuromuscular Blockade to Facilitate BMV

Head and Neck Maneuvers to Open the Upper Airway

Oral and Nasal Pharyngeal Airways

Ventilation Parameters for Bag-Mask Ventilation

Stomach Inflation, Sellick Maneuver, and Aspiration Risk With BMV

DIFFICULT AND IMPOSSIBLE MASK VENTILATION

Predicting Difficult or Impossible BMV

INTERPOSED BAGGING DURING RSI

EXPERIENCE, TRAINING, AND THE LEARNING CURVE FOR BMV

REAL-TIME MONITORING OF MASK VENTILATION

Pitfall of Oxygen Saturation Plethysmography

Importance of Waveform Capnography

Capnography Interpretation ( Video 21.2)

SUMMARY

CHAPTER 22 Extraglottic Devices

INTRODUCTION AND TERMINOLOGY

INDICATIONS FOR AN EGD

Primary Airway

Secondary Airway

CONTRAINDICATIONS FOR USE

INSERTING A SUPRAGLOTTIC DEVICE

General Technique for SGD Use ( Video 22.1)

Complications and Limitations

INSERTING A RETROGLOTTIC DEVICE

Insertion Technique—Assuming No Visualization ( Video 22.2)

Complications and Limitations

MANAGING THE IN SITU EXTRAGLOTTIC DEVICE

Assessing and Troubleshooting an EGD

Assessment

Troubleshooting Ventilation

Troubleshooting Oxygenation

OPTIMIZING EGD FUNCTION

WHEN TO CONSIDER SEMIELECTIVE EXCHANGE

GENERAL APPROACHES TO EGD EXCHANGE

Removal With Routine Intubation via Direct/Video Laryngoscopy

Intubate Through It

Surgical Airway

HOW TO PERFORM A SEMIELECTIVE SGD EXCHANGE FOR AN ETT

Blind Exchange

EXCHANGING A RETROGLOTTIC DEVICE

SUMMARY

CHAPTER 23 Direct Laryngoscopy

INTRODUCTION

DIRECT LARYNGOSCOPY AND VIDEO LARYNGOSCOPY SHOULD BE LEARNED TOGETHER

BASICS OF DIRECT LARYNGOSCOPY

ANATOMY FOR DIRECT LARYNGOSCOPY

PREPARATION AND ASSISTANCE

PREINTUBATION ASSESSMENT AND EQUIPMENT CHOICE

HANDLING THE LARYNGOSCOPE AND POSTURE OF THE OPERATOR

PATIENT POSITIONING

STANDARD DIRECT LARYNGOSCOPY TECHNIQUE ( Video 23.1)

PARAGLOSSAL (RETROMOLAR, RIGHT OR LEFT MOLAR) STRAIGHT-BLADE TECHNIQUE

BLIND INSERTION TECHNIQUE FOR THE STRAIGHT BLADE

INTUBATING THE TRACHEA (TUBE PASSAGE)

TROUBLESHOOTING DIFFICULT DIRECT LARYNGOSCOPY

Paralysis

External Laryngeal Manipulation

Positioning

Anterior Mandibular Advancement

Bougie (Endotracheal Tube Introducer)

FAILED LARYNGOSCOPY AND INTUBATION

CONFIRMING INTUBATION OF THE TRACHEA

CHAPTER 24 Video Laryngoscopy

INTRODUCTION

ADVANTAGES OF VIDEO LARYNGOSCOPES

CLASSIFICATION OF VIDEO LARYNGOSCOPES

WHEN TO USE VIDEO LARYNGOSCOPY COMPARED TO DIRECT LARYNGOSCOPY

DIFFERENCES IN TECHNIQUES FOR VIDEO LARYNGOSCOPY COMPARED TO DIRECT LARYNGOSCOPY

STANDARD GEOMETRY VIDEO LARYNGOSCOPES (MACINTOSH-STYLE)

Intubation With a Standard Geometry Video Laryngoscope ( Video 24.1)

Summary

HYPERANGULATED VIDEO LARYNGOSCOPES

Intubation With a Hyperangulated Video Laryngoscope ( Video 24.2)

Summary

VIDEO LARYNGOSCOPY AND THE SOILED AIRWAY

Proper Video Laryngoscope Technique in the Soiled Airway

VIDEO LARYNGOSCOPY AND DUAL-SCREEN INTUBATION

Technique for Dual-Screen Intubation With a Video Laryngoscope and Flexible Endoscope (see Chapter 28, Combination techniques)

COMPLICATIONS OF VIDEO LARYNGOSCOPES

CONCLUSION

CHAPTER 25 Flexible Endoscopic Intubation

INTRODUCTION

FEASIBILITY OF INTUBATING WITH A FLEXIBLE ENDOSCOPE

LEARNING CURVE FOR FLEXIBLE ENDOSCOPIC INTUBATION

INDICATIONS AND CONTRAINDICATIONS

PREPARATION CHECKLIST

APPROACH, PREPARATION AND TECHNIQUE

Patient Preparation

Equipment

Procedure of Flexible Endoscopic Intubation ( Video 25.1)

EDUCATION AND MAINTENANCE OF FLEXIBLE ENDOSCOPIC INTUBATION SKILLS

COMPLICATIONS

CHAPTER 26 Tracheal Intubation Using Optical Stylets

INTRODUCTION

DESIGN CHARACTERISTICS OF OPTICAL STYLETS

TYPES OF OPTICAL STYLETS

INTUBATION TECHNIQUE USING OPTICAL STYLETS ( Video 26.1)

ADVANTAGES OF THE OPTICAL STYLETS (SEE TABLE 26.1)

DISADVANTAGES OF THE OPTICAL STYLETS (SEE TABLE 26.1)

COMPLICATIONS ASSOCIATED WITH THE USE OF THE OPTICAL STYLETS

CLINICAL EVIDENCE OF THE OPTICAL STYLETS FOR TRACHEAL INTUBATION

SUMMARY

CHAPTER 27 Surgical Airways

INTRODUCTION

Description and General Approach

Indications and Contraindications

TECHNIQUE

Anatomy and Landmarks

Equipment

Technique

Complications

Alternatives to Open Surgical Techniques

CHAPTER 28 Combination Techniques

INTRODUCTION

INDICATIONS

COMBINATION OF SUPRAGLOTTIC DEVICE AND FLEXIBLE ENDOSCOPE

Technique ( Video 28.1)

DIRECT/VIDEO LARYNGOSCOPE AND FLEXIBLE ENDOSCOPE

Technique ( Video 28.3)

What Is the Literature Support for a Video Laryngoscope and Flexible Endoscope Combined Technique?

SUMMARY

CHAPTER 29 The Failed Airway

INTRODUCTION

THE FAILED AIRWAY

Failed (Missed) Attempt

Failed (Missed) Intubation

Failed Airway—Can’t Intubate, Can’t Oxygenate

Forced to Act/Forced to RSI

SECTION VI: Post-Intubation Management

30 Mechanical Ventilation and Post-Intubation Sedation, Hemodynamics, and Bundle

INTRODUCTION

MECHANICAL VENTILATION

Ventilation Modes

THE ALARMING VENTILATOR

VENTILATOR STRATEGIES BY CLINICAL PHENOTYPE

Normal Lungs

Acute Hypoxemic Respiratory Failure

Venovenous Extracorporeal Membrane Oxygenation

Exacerbation of Obstructive Lung Disease

ASSESSMENT OF SAFETY AND ADEQUACY OF MECHANICAL VENTILATION

VENTILATOR LIBERATION

SEDATION AND ANALGESIA

HEMODYNAMICS

BUNDLE OF POSTINVASIVE VENTILATION CARE

PEDIATRIC ISSUES

SUMMARY

ACKNOWLEDGMENTS

CHAPTER 31 Extubation and Tube Exchange

INTRODUCTION

EXTUBATION FAILURE

PLANNING FOR EXTUBATION

Extubation Criteria

Risk Stratification

Additional Testing

PROCESS OF EXTUBATION

General Extubation

Unplanned Extubation

Complications

ADJUNCTS TO EXTUBATION

Airway Exchange Catheters

Noninvasive Ventilation and High-Flow Nasal Cannula

Sedation During Extubation

ENDOTRACHEAL TUBE EXCHANGE

EVIDENCE

CHAPTER 32 Percutaneous Tracheostomy

INTRODUCTION

PROCEDURE: INDICATIONS AND TECHNIQUE

PEDIATRIC ISSUES

SUMMARY

SECTION VII: Special (Case-Based) Considerations

33 The Trauma Patient

GENERAL APPROACH TO THE TRAUMA AIRWAY

ASSESSMENT AND PREPARATION

ANATOMIC CONSIDERATIONS

PHYSIOLOGIC CONSIDERATIONS

AIRWAY MANAGEMENT STRATEGIES

Oxygenation/Preoxygenation

Endotracheal Intubation

Protecting the Cervical Spine

Adjuncts

Rapid Sequence Intubation

POSTINTUBATION MANAGEMENT

CHAPTER 34 The Neurologic Patient

INTRODUCTION

THE CLINICAL CHALLENGE—PREVENTION OF SECONDARY BRAIN INJURY

Hypoxemia

Hypotension

Hypercapnia

Elevated Intracranial Pressure

Neuromuscular Blockade Choice

Induction Agent Choice

SEIZURES AND STATUS EPILEPTICUS

NEUROMUSCULAR DISEASE

SUMMARY

CHAPTER 35 The Medical Patient

INTRODUCTION

SEPSIS

The Clinical Challenge

ACUTE HYPOXEMIC RESPIRATORY FAILURE

The Clinical Challenge

UPPER GASTROINTESTINAL BLEEDING

The Clinical Challenge

TOXIC OVERDOSE PATIENT

The Clinical Challenge

RIGHT VENTRICULAR FAILURE

The Clinical Challenge

CARDIOGENIC SHOCK FROM LEFT HEART DISEASE

The Clinical Challenge

UPPER AIRWAY OBSTRUCTION

The Clinical Challenge

SUBGLOTTIC AND TRACHEAL STENOSIS

The Clinical Challenge

OBSTRUCTIVE RESPIRATORY FAILURE

The Clinical Challenge

PREGNANCY

The Clinical Challenge

OBESITY

The Clinical Challenge

CONSIDERATION FOR INFECTION PREVENTION

The Clinical Challenge

SUMMARY

CHAPTER 36 The Pediatric Patient

INTRODUCTION

PREDICTABLE CHALLENGES IN PEDIATRIC AIRWAY MANAGEMENT

Anatomic Differences

Physiologic Differences

Cognitive Load in Pediatric Care

EQUIPMENT AND MEDICATION SELECTION

Equipment Selection

Drug Dosage and Selection

PREDICTING ANATOMIC AIRWAY DIFFICULTY IN PEDIATRICS

PROCEDURAL APPROACHES FOR BASIC AND ADVANCED AIRWAY MANAGEMENT IN CHILDREN

Tips for Successful Bag-Mask Ventilation in Children

Rapid Sequence Intubation in Children

Tips for Successful Endotracheal Intubation in Children

SELECT CAUSES OF PEDIATRIC DIFFICULT AIRWAYS

Infectious Causes

Noninfectious Causes

Congenital Anomalies

ADDRESSING THE FAILED AIRWAY

Extraglottic Devices

Cricothyrotomy

CHAPTER 37 The Surgical Patient

INTRODUCTION

APPROACH TO THE POSTOPERATIVE PATIENT’S AIRWAY

GENERAL POSTOPERATIVE CONCERNS

Airway Edema

Airway Injury

Recurrent Laryngeal Nerve Palsy

CAROTID ENDARTERECTOMY

Cervical Hematoma

Cranial Nerve Injury

Cervical Plexus Blocks

ESOPHAGECTOMY

Aspiration Risk

Pain Control and Pulmonary Mechanics

Pulmonary Edema and Fluid Overload

Anastomotic Injury

TRACHEAL RESECTION

Tracheal Tension

Laryngeal or Mucosal Edema

Postoperative Bleeding

Tracheal Obstruction

TRACHEOESOPHAGEAL AND BRONCHOPLEURAL FISTULA

LARYNGECTOMY

Preparation and Bedside Safety

Emergency Algorithm

TRACHEOSTOMY DISLODGMENT

Mature Versus Immature Stoma

Emergency Algorithm

OTHER POSTOPERATIVE CONCERNS FOR EMERGENCY AIRWAY MANAGEMENT

Neuromuscular Blockade

CHAPTER 38 Remote and Austere Environments

INTRODUCTION

CRITICAL CARE TRANSPORT

CONSIDERATIONS WITH ALTITUDE

MECHANICAL VENTILATION

MONITORING DEVICES

AIRWAY MANAGEMENT IN REMOTE HOSPITAL LOCATIONS

AIRWAY ASSESSMENT

PREOXYGENATION AND INTUBATION

ORGANIZATION

UNIQUE REMOTE LOCATIONS: RADIOLOGY

INTRAHOSPITAL TRANSPORT

TRULY AUSTERE ENVIRONMENT

SUMMARY

SECTION VIII: Organizational/Human Factors

39 Human Factors

INTRODUCTION

HUMAN EMOTION, STRESS, AND IMPLICATIONS FOR AIRWAY MANAGEMENT

THE PROBABILITY OF SUCCESS . . . OR FAILURE UNDER STRESS

CARDINAL RULE NUMBER 1: DO NOT WANDER, OR RUSH, INTO FAILURE

Thinking and Acting

Break the Cycle

CARDINAL RULE NUMBER 2: INTUBATE WITH A TEAM, NOT AN AUDIENCE

Talk to the Team

Crisis Resource Management

CHAPTER 40 Organizational Factors

INTRODUCTION

CLINICAL PRACTICES GUIDELINES

DRUG ORGANIZATION

AIRWAY CARTS

PREPARING FOR THE DIFFICULT AIRWAY, AND COMMUNICATING THIS TO OTHERS

DIFFICULT AIRWAY RESPONSE TEAMS

AIRWAY LEADS

QUALITY IMPROVEMENT

CHECKLISTS

SIMULATION

PHYSICAL LAYOUT

RESOURCE UTILIZATION

SUMMARY

CHAPTER 41 Airway Management Research

INTRODUCTION

Video Versus Direct Laryngoscopy

Bougie Versus Stylet

Etomidate Versus Ketamine

CHALLENGES WITH AIRWAY MANAGEMENT RESEARCH

Challenge 1: What Is the Patient Population?

Challenge 2: What Is the Intervention?

Challenge 3: What Is the Outcome of Interest?

Challenge 4: What Is the Design?

Challenge 5: Problems With Confounding Variables

TAKEAWAYS, FUTURE DIRECTIONS, AND LINGERING QUESTIONS

Index

 

An aparitie	28 aug 2024
Autor	Jarrod Mosier MD, PLLC, Calvin A Brown, III MD, Matteo Parotto M.D., Ph.D, Raquel Rae Bartz
Dimensiuni	178 x 254 mm
Editura	LWW
Format	Paperback
ISBN	9781975214203
Limba	Engleza
Nr pag	400