Critical care clinics
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Critical care clinics · Jul 2000
ReviewThe role of fiberoptic bronchoscopy in airway management of the critically ill patient.
Fiberoptic bronchoscopes (FOB) play a pivotal role in airway management in the operating room and critical care environments. This article examines the role of FOBs in modern airway management based on a review of recent literature and personal experience.
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Critical care clinics · Jul 2000
ReviewAirway management and direct laryngoscopy. A review and update.
Direct laryngoscopy is the direct visualization of the larynx while using a rigid laryngoscope to distract the structures of the upper airway. This article reviews the anatomy relevant to laryngoscopy and then presents a stepwise approach to the procedure. Alternative intubation techniques, positioning, laryngoscopy blades, and stylets are then covered. Pharmacologic adjuncts are discussed briefly as they relate to the difficult airway and incorporation into overall airway management.
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Despite having been a known surgical procedure for over 5000 years, the specifics of how, when, and why to perform a surgical airway are still debated. With new procedures, equipment, and techniques, operative airway management is becoming more complex. ⋯ Unlike Dr. Jackson in 1909, surgeons today have to evaluate these new procedures not only by their efficacy but also by their cost effectiveness.
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Tracheal insufflation of oxygen has at least three major uses for chronic oxygen supplementation through a percutaneous catheter, it is an adjunctive measure to enhance gas exchange during mechanical ventilation, and it provides an emergency therapy for oxygen delivery with upper airway obstruction. In this article the mechanisms of gas exchange and techniques of oxygen delivery are described for each of these major uses.
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Patients who are difficult to intubate are randomly encountered. Patients who are in the postoperative period or who have suffered trauma have a greater chance of being difficult to intubate. The ability to quickly mobilize trained personnel and advanced equipment provides the best chance for a good outcome for these patients. Practice in placement of and intubation with LMAs is an important step toward providing an extensive safety net for patients needing intubation.