Gaszyński Tomasz
Sekcja Przyzadowego Udrozniania Dróg Oddechowych PTAiIT, Katedra Anestezjologii i Intensywnej Terapii, Uniwersytet Medyczny w Łodzi.
Anestezjol Intens Ter. 2009 Oct-Dec;41(4):230-3.
Airway management is a critical skill that must be mastered by all emergency physicians. Retrograde intubation was first described in 1960, and since then it has been used as an alternative method when the classical approach to establish an artificial airway fails. Although it may be difficult due to anatomical and/or technical reasons, it requires limited equipment, is easy to learn, and has few contraindications
The author presents their own modification of the standard technique of retrograde intubation, using a gastric tube as a guide. After puncture of the cricothyroid membrane and passage of a guide wire (epidural catheter), a gastric tube is passed over the guide wire in a retrograde direction, through the previously dilated cricothyroid membrane, instead of via mouth. An endotracheal tube is then advanced over the gastric tube and inserted into the trachea.
The method was tested and compared with a standard one on a manikin model by 38 anaesthesiologists and anaesthesia residents. The success rate was 96% for the modified method, and 65% for the standard method.
The retrograde passage of a guide catheter (e.g., gastric tube) through the cricothyroid membrane may be more effective than the routine method, when it is introduced though the mouth.
气道管理是所有急诊医生都必须掌握的一项关键技能。逆行插管于1960年首次被描述，自那时起，当建立人工气道的传统方法失败时，它就被用作一种替代方法。尽管由于解剖学和/或技术原因它可能具有难度，但它所需设备有限，易于学习，且几乎没有禁忌证。
作者介绍了他们自己对逆行插管标准技术的改良方法，使用胃管作为引导。在穿刺环甲膜并置入导丝（硬膜外导管）后，将胃管沿导丝逆行穿过先前扩张的环甲膜，而不是经口腔。然后将气管导管沿胃管推进并插入气管。
38名麻醉医生和麻醉住院医师在人体模型上对该方法进行了测试，并与标准方法进行了比较。改良方法的成功率为96%，标准方法的成功率为65%。
当引导导管（如胃管）经环甲膜逆行置入时，可能比经口腔置入的常规方法更有效。
