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儿科气道管理:提高安全性。

Airway management in pediatrics: improving safety.

作者信息

Zimmermann Lea, Maiellare Federica, Veyckemans Francis, Fuchs Alexander, Scquizzato Tommaso, Riva Thomas, Disma Nicola

机构信息

Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Unit for Research in Anesthesia, IRCCS Istituto Giannina Gaslini, Via G. Gaslini 5, 16100, Genoa, Italy.

出版信息

J Anesth. 2025 Feb;39(1):123-133. doi: 10.1007/s00540-024-03428-z. Epub 2024 Nov 18.

Abstract

Airway management in children poses unique challenges due to the different anatomy, physiology, and pathophysiology across the pediatric age span. The recently published joint European Society of Anaesthesiology and Intensive Care-British Journal of Anaesthesia (ESAIC-BJA) neonatal and infant airway management guidelines provide recommendations and suggestions to support clinicians in deciding the best strategy. These guidelines represent a framework with the most recent and up-to-date evidence, from the initial assessment to the management of normal and difficult airways up to the extubation phase. However, such guidelines have intrinsic limitations due to the lack of supporting evidence in various fields of airway management. Pediatric institutions should adopt guidelines after careful internal review according to the local circumstances, including caseload, equipment and expertise. The current narrative review focused on providing references and practical tips on pediatric airway management, which is still not completely elucidated. Moreover, the authors put particular emphasis on the influence of human factors on the overall success of tracheal intubation, the incidence of complications, and the outcomes for patients.

摘要

由于小儿各年龄段的解剖学、生理学和病理生理学存在差异,儿童气道管理面临着独特的挑战。欧洲麻醉学会和重症监护学会与英国麻醉学杂志(ESAIC - BJA)最近联合发布的新生儿和婴儿气道管理指南提供了建议,以支持临床医生确定最佳策略。这些指南代表了一个从初始评估到正常和困难气道管理直至拔管阶段的、包含最新和最前沿证据的框架。然而,由于气道管理各个领域缺乏支持性证据,此类指南存在内在局限性。儿科机构应根据当地情况,包括病例数量、设备和专业知识,在仔细内部审查后采用指南。当前的叙述性综述重点在于提供小儿气道管理的参考文献和实用技巧,而这一领域仍未得到充分阐明。此外,作者特别强调了人为因素对气管插管总体成功率、并发症发生率及患者预后的影响。

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