Department of Otolaryngology-Head and Neck Surgery, Medical School, University of Michigan, Ann Arbor, Michigan, USA.
Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Wayne State University, Detroit, Michigan, USA.
Otolaryngol Head Neck Surg. 2021 May;164(5):1040-1043. doi: 10.1177/0194599820960728. Epub 2020 Oct 13.
It is impossible to secure the airway of a patient with "neck-only" breathing transorally or transnasally. Surgical removal of the larynx (laryngectomy) or tracheal rerouting (tracheoesophageal diversion or laryngotracheal separation) creates anatomic discontinuity. Misguided attempts at oral intubation of neck breathers may cause hypoxic brain injury or death. We present national data from the American Academy of Otolaryngology-Head and Neck Surgery, the American Head and Neck Society, and the United Kingdom's National Reporting and Learning Service. Over half of US otolaryngologist respondents reported instances of attempted oral intubations among patients with laryngectomy, with a mortality rate of 26%. UK audits similarly revealed numerous resuscitation efforts where misunderstanding of neck breather status led to harm or death. Such data underscore the critical importance of staff education, patient engagement, effective signage, and systems-based best practices to reliably clarify neck breather status and provide necessary resources for safe patient airway management.
经口或经鼻对“仅颈部”呼吸的患者进行气道管理是不可能的。通过外科手术切除喉部（喉切除术）或气管改道（气管食管分流术或喉气管分离术）会造成解剖连续性中断。对颈部呼吸患者进行盲目经口插管尝试可能导致缺氧性脑损伤或死亡。我们提供了来自美国耳鼻喉科学会、美国头颈外科学会和英国国家报告和学习服务的数据。超过一半的美国耳鼻喉科医生受访者报告了在喉切除术患者中进行经口插管尝试的情况，死亡率为 26%。英国的审核同样揭示了许多复苏努力，由于对颈部呼吸者状态的误解，导致了伤害或死亡。此类数据突出强调了员工教育、患者参与、有效标识以及基于系统的最佳实践的重要性，以可靠地明确颈部呼吸者状态并为安全的患者气道管理提供必要资源。
