Walas Wojciech, Aleksandrowicz Dawid, Borszewska-Kornacka Maria, Gaszyński Tomasz, Helwich Ewa, Migdał Marek, Piotrowski Andrzej, Siejka Grażyna, Szczapa Tomasz, Bartkowska-Śniatkowska Alicja
Department of Paediatric Anaesthesiology and Intensive Care, University Clinical Hospital, Opole, Poland.
Anaesthesiol Intensive Ther. 2017;49(5):336-349. doi: 10.5603/AIT.2017.0079.
Tracheal intubation may be defined as an artificial airway established in order to provide mechanical ventilation of the lungs during surgical procedures under general anaesthesia, treatment in an intensive care unit, as well as in emergency situations. Difficulties encountered during intubation may cause hypoxia, hypoxic brain injury and, in extreme situations, may result in the patient's death. There may be unanticipated and anticipated difficult airway. Children form a specific group of patients as there are significant differences in both anatomy and physiology. There are some limitations in equipment used for the airway management in children. There are only few paediatric difficult airway guidelines available, some of which have significant limitations. The presented algorithm was created by a group of specialists who represent the Polish Society of Anaesthesiology and Intensive Therapy, as well as the Polish Neonatology Society. This algorithm is intended for the unanticipated difficult airway in children and can be used in all age groups. It covers both elective intubation, as well as rescue techniques. A guide forms an integral part of the algorithm. It describes in detail all stages of the algorithm considering some modifications in a specific age group, e.g. neonates. The main aim of Stage I is to optimise conditions for face mask ventilation, laryngoscopy and intubation. Stage IIA focuses on maximising the chances of successful intubation when face mask ventilation is possible. Stage IIB outlines actions aimed at improving face mask ventilation. Stage IIIA describes the use of a SAD (Supraglottic Airway Device) during effective face mask ventilation or in a CICV (Cannot Intubate, Cannot Ventilate) situation. Stage IIIB outlines intubation through a SAD. Stage IV describes rescue techniques and outlines possible options of either proceeding with surgery or postponing it, depending on clinical situation.
气管插管可定义为一种人工气道，其建立目的是在全身麻醉下的外科手术过程中、重症监护病房的治疗以及紧急情况下为肺部提供机械通气。插管过程中遇到的困难可能导致缺氧、缺氧性脑损伤，在极端情况下，可能导致患者死亡。气道困难可能是意料之外的，也可能是可预见的。儿童是一类特殊的患者群体，因为他们在解剖学和生理学方面都存在显著差异。用于儿童气道管理的设备存在一些局限性。目前可用的儿科困难气道指南很少，其中一些存在重大局限性。本算法由代表波兰麻醉学与重症治疗学会以及波兰新生儿学会的一组专家创建。该算法适用于儿童意外困难气道，可用于所有年龄组。它涵盖了择期插管以及抢救技术。指南是该算法的一个组成部分。它详细描述了算法的所有阶段，并考虑了特定年龄组（如新生儿）的一些修改。第一阶段的主要目标是优化面罩通气、喉镜检查和插管的条件。第二阶段A侧重于在面罩通气可行时最大限度地提高插管成功的机会。第二阶段B概述了旨在改善面罩通气的措施。第三阶段A描述了在有效的面罩通气期间或在“无法插管、无法通气”（CICV）情况下使用声门上气道装置（SAD）。第三阶段B概述了通过SAD进行插管。第四阶段描述了抢救技术，并根据临床情况概述了继续手术或推迟手术的可能选择。
