Bjurström Martin F, Bodelsson Mikael, Sturesson Louise W
Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund, Sweden.
Anesthesiol Res Pract. 2019 Jan 27;2019:6780254. doi: 10.1155/2019/6780254. eCollection 2019.
Death and severe morbidity attributable to anesthesia are commonly associated with failed difficult airway management. When an airway emergency develops, immediate access to difficult airway equipment is critical for implementation of rescue strategies. Previously, national expert consensus guidelines have provided only limited guidance for the design and setup of a difficult airway trolley. The overarching aim of the current work was to create a dedicated difficult airway trolley (for patients>12 years old) for use in anesthesia theatres, intensive care units, and emergency departments. A systematic literature search was performed, using the PubMed, Embase, and Google Scholar search engines. Based on evidence presented in 11 national or international guidelines, and peer-reviewed journals, we present and outline a difficult airway trolley organized to accommodate sequential progression through a four-step difficult airway algorithm. The contents of the top four drawers correspond to specific steps in the airway algorithm (A = intubation, B = oxygenation via a supraglottic airway device, C = facemask ventilation, and D = emergency invasive airway access). Additionally, specialized airway equipment may be included in the fifth drawer of the proposed difficult airway trolley, thus enabling widespread use. A logically designed, guideline-based difficult airway trolley is a vital resource for any clinician involved in airway management and may aid the adherence to difficult airway algorithms during evolving airway emergencies. Future research examining the availability of rescue airway devices in various clinical settings, and simulation studies comparing different types of difficult airway trolleys, are encouraged.
麻醉导致的死亡和严重并发症通常与困难气道管理失败有关。当气道紧急情况发生时，能立即获取困难气道设备对于实施救援策略至关重要。此前，国家专家共识指南对困难气道推车的设计和设置仅提供了有限的指导。当前这项工作的总体目标是打造一款专门用于麻醉手术室、重症监护病房和急诊科的困难气道推车（适用于12岁以上患者）。利用PubMed、Embase和谷歌学术搜索引擎进行了系统的文献检索。基于11项国家或国际指南及同行评审期刊中呈现的证据，我们展示并概述了一款困难气道推车，其设计旨在适应通过四步困难气道算法的连续进展。最上面四个抽屉的内容对应气道算法中的特定步骤（A = 插管，B = 通过声门上气道装置给氧，C = 面罩通气，D = 紧急有创气道通路）。此外，在所提议的困难气道推车的第五个抽屉中可纳入专门的气道设备，从而便于广泛使用。一款设计合理、基于指南的困难气道推车对于任何参与气道管理的临床医生而言都是至关重要的资源，并且在不断演变的气道紧急情况中可能有助于遵循困难气道算法。鼓励未来开展研究，考察各种临床环境中救援气道设备的可及性，以及比较不同类型困难气道推车的模拟研究。
