Dash H H
Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi 110 029, India.
Neurol India. 2001 Jun;49 Suppl 1:S61-74.
Respiratory complications play an important part in the morbidity and mortality of critically ill neurological patients. Assurance of airway patency is of primary concern in such patients. A plethora of airway maintenance techniques and devices have been recommended for securing and maintaining the airway. But, translaryngeal intubation through the oral route is the safest and most preferred technique. Proper assessment and adequate preparation of the patient before intubation helps to avert crises. In difficult intubation one may secure and maintain the airway by placing a laryngeal mask airway (LMA). The role of early tracheotomy in patients who require prolonged ventilatory support can not be overemphasized. However, the development of inert and softer endotracheal tubes with low pressure cuff has reduced the complications associated with endotracheal intubation. Finally and most importantly the best place to acquire competence in securing the airway is the operation theater not the intensive care unit.
呼吸并发症在重症神经科患者的发病率和死亡率中起着重要作用。确保气道通畅是这类患者首要关注的问题。为确保和维持气道，人们推荐了大量气道维护技术和设备。但是，经口经喉插管是最安全且最常用的技术。插管前对患者进行适当评估和充分准备有助于避免危机。在困难插管情况下，可通过放置喉罩气道（LMA）来确保和维持气道。对于需要长期通气支持的患者，早期气管切开术的作用再怎么强调也不为过。然而，惰性且更柔软、带有低压套囊的气管内导管的发展减少了与气管内插管相关的并发症。最后也是最重要的一点，获得气道管理技能的最佳场所是手术室而非重症监护病房。
