Garg Rakesh, Gupta Anju
Rakesh Garg, Department of Anaesthesiology, Pain and Palliative Care, Dr BRAIRCH, All India Institute of Medical Sciences, AIIMS, New Delhi1 10029, India.
World J Clin Cases. 2015 Nov 16;3(11):926-9. doi: 10.12998/wjcc.v3.i11.926.
Airway evaluation and its management remains an ever emerging clinical science. Present airway management tools are static and do not provide dynamic airway management option. Visualized procedures like ultrasound (US) provide point of care real time dynamic views of the airway in perioperative, emergency and critical care settings. US can provide dynamic anatomical assessment which is not possible by clinical examination alone. US aids in detecting gastric contents and the nature of gastric contents (clear fluid, thick turbid or solid) as well. US can help in predicting endotracheal tube size by measuring subglottic diameter and diameter of left main stem bronchus. US was found to be a sensitive in detecting rotational malposition of LMA in children. Also, US is the fastest and highly sensitive tool to rule out a suspected intraoperative pneumothorax. In intensive care units, US helps torule out causes of inadequate ventilation, determine the tracheal width and distance from the skin to predict tracheotomy tube size and shape and assist with percutaneous dilatational tracheostomy. US can help in confirming the correct tracheal tube placement by dynamic visualisation of the endotracheal tube insertion, widening of vocal cords (children), and bilateral lung-sliding and diaphragmatic movement. Thus, ultrasonography has brought a paradigm shift in the practise of airway management. With increasing awareness, portability, accessibility and further sophistication in technology, it is likely to find a place in routine airway management. We are not far from the time when all of us will be carrying a pocket US machine like stethoscopes to corroborate our clinical findings at point of care.
气道评估及其管理仍是一门不断发展的临床科学。目前的气道管理工具是静态的，无法提供动态气道管理选项。像超声（US）这样的可视化检查在围手术期、急诊和重症监护环境中可提供即时的气道实时动态视图。超声能够提供动态解剖学评估，这是仅通过临床检查无法实现的。超声还有助于检测胃内容物及其性质（清亮液体、浓稠浑浊物或固体）。超声可以通过测量声门下直径和左主支气管直径来帮助预测气管插管尺寸。研究发现，超声在检测儿童喉罩旋转错位方面很敏感。此外，超声是排除疑似术中气胸最快且高度敏感的工具。在重症监护病房，超声有助于排除通气不足的原因，确定气管宽度以及皮肤到气管的距离，以预测气管切开管的尺寸和形状，并协助进行经皮扩张气管切开术。超声可以通过动态观察气管插管插入情况、声带增宽（儿童）以及双侧肺滑动和膈肌运动来帮助确认气管插管的正确位置。因此，超声检查在气道管理实践中带来了范式转变。随着人们意识的提高、设备便携性和可及性的提升以及技术的进一步完善，超声很可能会在常规气道管理中占据一席之地。我们距离所有人都像携带听诊器一样携带便携式超声仪以在床边证实临床发现的时代已不远了。
