Complex intubation, cricothyrotomy and tracheotomy

• Published in: B-ENT (Leuven) Vol. Suppl 26; no. 2; p. 103
• Main Authors: Leach, R, Hachimi Idrissi, S, Meulemans, J, Monsieurs, K, Vanderveken, O, Vander Poorten, V
• Format: Journal Article
• Language: English
• Published: Belgium 2016
• ISSN: 1781-782X

Complex intubation, cricothyrotomy and tracheotomy. Successful management of a difficult airway begins with recognizing the potential problem. When the patient cannot breathe spontaneously, oxygenation and ventilation should start first with bag-valve ventilation, with or without an airway adjunct such as a Mayo cannula, followed by an orotrache4l intubation attempt, performed by an experienced emergency doctor. If orotracheal intubation fails, a quick decision must be made regarding surgical options. In a "cannot intubate, cannot ventilate" situation, a surgical cricothyrotomy should be considered. When orotracheal intubation is impossible, but bag-valve or laryngeal mask ventilation is possible, an urgent surgical tracheostomy should be performed. In the long run, patients in need of longterm artificial ventilation will need a percutaneous or open tracheostomy. This review provides an update of all aspects of immediate and long-term airway management.