Leach R, Hachimi Idrissi S, Meulemans J, Monsieurs K, Vanderveken O, Vander Poorten V
B-ENT. 2016;Suppl 26(2):103-118.
Complex intubation, cricothyrotomy and tracheotomy. Successful management of a difficult airway begins with recognizing the potential problem. When the patient cannot breathe spontaneously, oxygenation and ventilation should start first with bag-valve ventilation, with or without an airway adjunct such as a Mayo cannula, followed by an orotrache4l intubation attempt, performed by an experienced emergency doctor. If orotracheal intubation fails, a quick decision must be made regarding surgical options. In a "cannot intubate, cannot ventilate" situation, a surgical cricothyrotomy should be considered. When orotracheal intubation is impossible, but bag-valve or laryngeal mask ventilation is possible, an urgent surgical tracheostomy should be performed. In the long run, patients in need of longterm artificial ventilation will need a percutaneous or open tracheostomy. This review provides an update of all aspects of immediate and long-term airway management.
复杂插管、环甲膜切开术和气管切开术。困难气道的成功管理始于识别潜在问题。当患者无法自主呼吸时，应首先通过球囊面罩通气进行氧合和通气，可使用或不使用诸如梅奥套管等气道辅助装置，随后由经验丰富的急诊医生尝试经口气管插管。如果经口气管插管失败，必须迅速就手术方案做出决定。在“无法插管、无法通气”的情况下，应考虑进行手术环甲膜切开术。当经口气管插管不可能，但球囊面罩或喉罩通气可行时，应紧急进行手术气管切开术。从长远来看，需要长期人工通气的患者将需要经皮或开放性气管切开术。本综述提供了即时和长期气道管理各方面的最新情况。
