Department of Anaesthetics and Intensive Care, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK.
Br J Anaesth. 2012 May;108(5):800-6. doi: 10.1093/bja/aes030. Epub 2012 Mar 13.
There is growing evidence that airway complications are relatively common in critical care. Strategies have been suggested to decrease their incidence.
We conducted a telephone survey of all adult intensive care units (ICUs) in Australia and New Zealand to establish the current practice regarding strategies used to reduce airway complications in five key areas: (i) use of capnography; (ii) care of oral tracheal tubes; (iii) care of tracheostomy tubes; (iv) difficult and failed intubation; and (v) training and medical staffing.
Of 176 ICU meeting inclusion criteria, 171 agreed to participate. Capnography is used during tracheal intubation in 88% of ICUs and for continuous monitoring in 64%. Protocols for advancing or partially withdrawing malpositioned tracheal tubes are used by 54% of units, with most allowing repositioning by unaccredited nurses. A small minority of ICUs use bed head signs to identify patients with 'critical airways' or laryngectomy, while only 8% have specific protocols for the care of these high-risk patients. Tracheostomy emergency algorithms are available in 13% of ICUs. At night, a doctor is exclusively assigned to 73% of units, although in 72%, the night doctor is not required to have prior anaesthetic/airway training. In 97% of the institutions surveyed, the senior doctor relied upon for airway emergencies at night is either non-resident or working elsewhere in the hospital.
Our data suggest that several possible strategies for avoiding airway complications in ICU patients dependent on an artificial airway are poorly implemented. This may expose these patients to avoidable risk.
越来越多的证据表明，气道并发症在重症监护中较为常见。已经提出了一些策略来降低其发生率。
我们对澳大利亚和新西兰所有成人重症监护病房（ICU）进行了电话调查，以确定在以下五个关键领域中用于减少气道并发症的策略的当前实践：（i）使用二氧化碳描记术；（ii）气管内导管的护理；（iii）气管切开管的护理；（iv）困难和失败的插管；和（v）培训和医疗人员配备。
在符合纳入标准的 176 个 ICU 中，有 171 个同意参与。在 88％的 ICU 中，在气管插管期间使用二氧化碳描记术，在 64％的 ICU 中进行连续监测。54％的单位使用推进或部分撤出错位气管导管的方案，大多数允许非认证护士重新定位。少数 ICU 使用床头标志来识别具有“关键气道”或喉切除术的患者，而只有 8％的 ICU 具有针对这些高风险患者的护理特定方案。在 13％的 ICU 中可获得气管造口术紧急算法。在夜间，有 73％的单位专门分配一名医生，尽管在 72％的单位中，夜间医生不需要事先接受麻醉/气道培训。在所调查的 97％的机构中，夜间依赖于气道紧急情况的高级医生要么是非驻地医生，要么在医院的其他地方工作。
我们的数据表明，一些可能的策略可用于避免依赖人工气道的 ICU 患者发生气道并发症，但实施情况不佳。这可能使这些患者面临可避免的风险。
