Mutlak Haitham, Weber Christian Friedrich, Meininger Dirk, Cuca Colleen, Zacharowski Kai, Byhahn Christian, Schalk Richard
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Goethe-University Hospital, Theodor-Stern Kai 7-10, 60590 Frankfurt, Germany.
Department of Anesthesiology, Main-Kinzig-Kliniken, Herzbachweg 14, 63571 Gelnhausen, Germany.
Clinics (Sao Paulo). 2017 Jul;72(7):422-425. doi: 10.6061/clinics/2017(07)06.
: The role of supraglottic airway devices in emergency airway management is highlighted in international airway management guidelines. We evaluated the application of the new generation laryngeal tube suction (LTS-II/LTS-D) in the management of in-hospital unexpected difficult airway and cardiopulmonary resuscitation.
: During a seven-year period, patients treated with a laryngeal tube who received routine anesthesia and had an unexpected difficult airway (Cormack Lehane Grade 3-4), who underwent cardiopulmonary resuscitation, or who underwent cardiopulmonary resuscitation outside the operating room and had a difficult airway were evaluated. Successful placement of the LTS II/LTS-D, sufficient ventilation, time to placement, number of placement attempts, stomach content, peripheral oxygen saturation/end-tidal carbon dioxide development (SpO2/etCO2) over 5 minutes, subjective overall assessment and complications were recorded.
: In total, 106 adult patients were treated using an LTS-II/LTS-D. The main indication for placement was a difficult airway (75%, n=80), followed by cardiopulmonary resuscitation (25%, n=26) or an overlap between both (18%, n=19). In 94% of patients (n=100), users placed the laryngeal tube during the first attempt. In 93% of patients (n=98), the tube was placed within 30 seconds. A significant increase in SpO2 from 97% (0-100) to 99% (5-100) was observed in the whole population and in cardiopulmonary resuscitation patients. The average initial etCO2 of 39.5 mmHg (0-100 mmHg) decreased significantly to an average of 38.4 mmHg (10-62 mmHg) after 5 minutes. A comparison of cardiopulmonary resuscitation patients with non-cardiopulmonary resuscitation patients regarding gastric contents showed no significant difference.
: LTS-D/LTS-II use for in-hospital unexpected difficult airway management provides a secure method for primary airway management until other options such as video laryngoscopy or fiber optic intubation become available.
国际气道管理指南强调了声门上气道装置在紧急气道管理中的作用。我们评估了新一代喉管吸引器（LTS-II/LTS-D）在医院内意外困难气道管理及心肺复苏中的应用。
在七年期间，对接受常规麻醉且出现意外困难气道（Cormack Lehane 3-4级）、接受心肺复苏或在手术室之外接受心肺复苏且存在困难气道的使用喉管治疗的患者进行评估。记录LTS II/LTS-D的成功置入情况、充足通气情况、置入时间、置入尝试次数、胃内容物、5分钟内的外周血氧饱和度/呼气末二氧化碳变化（SpO2/etCO2）、主观总体评估及并发症。
总共106例成年患者使用LTS-II/LTS-D进行治疗。置入的主要指征是困难气道（75%，n = 80），其次是心肺复苏（25%，n = 26）或两者重叠情况（18%，n = 19）。94%的患者（n = 100）使用者在首次尝试时成功置入喉管。93%的患者（n = 98）在30秒内完成置入。在整个人群及心肺复苏患者中，观察到SpO2从97%（0-100）显著增加至99%（5-100）。平均初始呼气末二氧化碳分压为39.5 mmHg（0-100 mmHg），5分钟后显著降至平均38.4 mmHg（10-62 mmHg）。比较心肺复苏患者与非心肺复苏患者的胃内容物情况，未发现显著差异。
LTS-D/LTS-II用于医院内意外困难气道管理，为主要气道管理提供了一种安全方法，直至诸如视频喉镜或纤维光导插管等其他选择可用。
