Myatra Sheila Nainan, Ahmed Syed Moied, Kundra Pankaj, Garg Rakesh, Ramkumar Venkateswaran, Patwa Apeksh, Shah Amit, Raveendra Ubaradka S, Shetty Sumalatha Radhakrishna, Doctor Jeson Rajan, Pawar Dilip K, Ramesh Singaravelu, Das Sabyasachi, Divatia Jigeeshu Vasishtha
Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Department of Anaesthesiology and Critical Care, J N Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India.
Indian J Crit Care Med. 2017 Mar;21(3):146-153. doi: 10.4103/ijccm.IJCCM_57_17.
Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often lifesaving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with under evaluation of the airway and suboptimal response to preoxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; Wherever, robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the (AIDAA) and Indian Society of Anaesthesiologists. Noninvasive positive pressure ventilation for preoxygenation provides adequate oxygen stores during TI for patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnea before hypoxemia sets in. High flow nasal cannula oxygenation at 60-70 L/min may also increase safety during intubation of critically ill patients. Stable hemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.
气管插管（TI）是重症监护病房（ICU）的常规操作，常常能挽救生命。与手术室的可控条件不同，患有呼吸衰竭和休克的重症患者生理上不稳定。这些因素，再加上气道评估不足和对预充氧的反应欠佳，是导致ICU中TI期间发生严重低氧血症和心血管崩溃等危及生命并发症的高发生率的原因。全印度困难气道协会（AIDAA）提出了重症患者气道安全管理的逐步计划。这些指南是根据现有证据制定的；在缺乏有力证据的情况下，通过气道专家的共识意见得出建议，其中纳入了对发送给（AIDAA）成员和印度麻醉医师协会成员的问卷的回复。用于预充氧的无创正压通气可为患有呼吸疾病的患者在TI期间提供充足的氧储备。以15 L/分钟的流量经鼻吹入氧气可增加低氧血症出现前的呼吸暂停持续时间。以60 - 70 L/分钟的流量进行高流量鼻导管给氧也可能增加重症患者插管期间的安全性。在快速序贯诱导期间必须维持稳定的血流动力学和气体交换。在ICU的常规气道管理期间实施插管方案是必要的。坚持采用包含使用插管辅助工具和气道救援设备及策略的困难气道管理计划是有用的。
