Pediatric emergency medicine trisk 0179 0179
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (102.19 KB, 1 trang )
Supraglottic Airways
Laryngeal mask airways (LMAs) are the most common supraglottic airways
(SGAs) used as rescue devices for adults and children ( e-Fig. 8.2 ). They
consist of a teardrop-shaped cuff which can be inflatable or self-inflating that
surrounds an aperture at the end of a tube. When properly inserted, the cuff sits in
the hypopharynx above and behind the glottis opening. Airflow through the
device is directed anteriorly through the glottis into the lungs. SGAs are
manufactured in a range of sizes that are suitable for patients throughout the
pediatric age spectrum, including newborns and infants. Multiple models are
available. Some SGAs allow the passage of an ETT through the aperture into the
trachea. Second-generation SGAs have integrated channels that allow gastric
access for decompression of air following bag mask ventilation, or gastric
contents in unfasted patients. Numerical sizing conventions of SGAs are
nonuniform among manufacturers, however most devices have information on
either their packaging or the device itself displaying the correct patient size and
volume of air for cuff inflation a given device requires. Studies in anesthesia,
emergency medicine, and pediatrics have shown that SGAs are easy to place,
require very little training to use effectively, and have a very low complication
rate. Clinical data on SGA use on adults with cardiac arrest in the prehospital
arena and depressed newborns in the delivery suite have demonstrated
comparable effectiveness and equivalent or improved clinical outcomes when
compared with prehospital TI and BVM ventilation, respectively.
Other Supraglottic Devices
The following list describes several additional available options for rescue
devices during emergency airway management. All of these devices have in
common that there are limited clinical data outside the operating room
demonstrating ease of use or relative efficacy in pediatric patients.
Esophageal Combination Tube (Combitube)
The Combitube is a dual-lumen tube with two inflatable cuffs: a larger proximal
one and a smaller distal one. When blindly inserted, the device usually enters the
esophagus (>95% of attempts), but is designed in such a way that ventilation can
be accomplished with either esophageal or tracheal placement, depending on
which port is attached to the bag-valve device. Combitubes only exist in sizes
small enough to accommodate a patient 1.2 m in height; thus, the pediatric
application of Combitubes is limited to older children.
Laryngeal Tube
