薛富善

• 1:中国医学科学院北京协和医学院整形外科医院麻醉科

摘要(Abstract)：

危重症患者气管插管风险较大,反复或长时间气管插管可增加并发症发生概率。本文强调危重症患者困难气道问题和首次气管插管成功的重要性,分析预氧、氧合维持、血流动力学优化和工具选择对促进首次气管插管成功的作用,对气道管理的培训、处理流程和综合措施等进行阐述。

关键词(KeyWords)： 危重症;气道管理;急诊医学;重症监护;气管插管

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 薛富善

参考文献(References)：

• [1]SIMPSON G D,ROSS M J,MCKEOWN D W,et al.Tracheal intubation in the critically ill:a multi-centre national study of practice and complications[J].Br J Anaesth,2012,108(5):792-799.
• [2]NATT B S,MALO J,HYPES C D,et al.Strategies to improve first attempt success at intubation in critically ill patients[J].Br J Anaesth,2016,117(Suppl 1):i60-i68.
• [3]COOK T M,WOODALL N,HARPER J,et al.Major complications of airway management in the UK:results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society.Part 2:intensive care and emergency departments[J].Br J Anaesth,2011,106(5):632-642.
• [4]GRIESDALE D E,BOSMA T L,KURTH T,et al.Complications of endotracheal intubation in the critically ill[J].Intensive Care Med,2008,34(10):1835-1842.
• [5]MORT T C.The incidence and risk factors for cardiac arrest during emergency tracheal intubation:a justification for incorporating the ASA Guidelines in the remote location[J].J Clin Anesth,2004,16(7):508-516.
• [6]SAKLES J C,CHIU S,MOSIER J,et al.The importance of first pass success when performing orotracheal intubation in the emergency department[J].Acad Emerg Med,2013,20(1):71-78.
• [7]APFELBAUM J L,HAGBERG C A,CAPLAN R A,et al.Practice guidelines for management of the difficult airway:an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway[J].Anesthesiology,2013,118(2):251-270.
• [8]NORSKOV A K,ROSENSTOCK C V,WETTERSLEV J,et al.Diagnostic accuracy of anaesthesiologistsprediction of difficult airway management in daily clinical practice:a cohort study of 188 064patients registered in the Danish Anaesthesia Database[J].Anaesthesia,2015,70(3):272-281.
• [9]DE JONG A,MOLINARI N,TERZI N,et al.Early identification of patients at risk for difficult intubation in the intensive care unit:development and validation of the MACOCHA score in a multicenter cohort study[J].Am J Respir Crit Care Med,2013,187(8):832-839.
• [10]MOSIER J M,MALO J,SAKLES J C,et al.The impact of a comprehensive airway management training program for pulmonary and critical care medicine fellows:three-year experience[J].Ann Am Thorac Soc,2015,12(4):539-548.
• [11]MORT T C.Preoxygenation in critically ill patients requiring emergency tracheal intubation[J].Crit Care Med,2005,33(11):2672-2675.
• [12]BAILLARD C,FOSSE J P,SEBBANE M,et al.Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients[J].Am J Respir Crit Care Med,2006,174(2):171-177.
• [13]WEINGART S D,TRUEGER N S,WONG N,et al.Delayed sequence intubation:aprospective observational study[J].Ann Emerg Med,2015,65(4):349-355.
• [14]MIGUEL-MONTANES R,HAJAGE D,MESSIKA J,et al.Use of high flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia[J].Crit Care Med,2015,43(3):574-583.
• [15]SEMLER M W,JANZ D R,LENTZ R J,et al.Randomized trial of apneic oxygenation during endotracheal intubation of the critically ill[J].Am J Respir Crit Care Med,2016,193(3):273-280.
• [16]VOURCH M,ASFAR P,VOLTEAU C,et al.High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients:a randomized controlled clinical trial[J].Intensive Care Med,2015,41(9):1538-1548.
• [17]OLIVEIRA JE SILVA L,CABRERA D,BARRIONUEVO P,et al.Effectiveness of apneic oxygenation during intubation:a systematic review and meta-analysis[J].Ann Emerg Med,2017,70(4):483-494.
• [18]GREEN R S,TURGEON A F,MCINTYRE L A,et al.Postintubation hypotension in intensive care unit patients:a multicenter cohort study[J].J Crit Care,2015,30(5):1055-1060.
• [19]SMISCHNEY N J,DEMIRCI O,RICTER B D,et al.Vasopressor use as a surrogate for post-intubation hemodynamic instability is associated with in-hospital and 90-day mortality:a retrospective cohort study[J].BMC Res Notes,2015,8:445.
• [20]LYON R M,PERKINS Z B,CHATTERJEE D,et al.Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia[J].Crit Care,2015,19(1):134.
• [21]WILCOX S R,BITTNER E A,ELMER J,et al.Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications[J].Crit Care Med,2012,40(6):1808-1813.
• [22]MOSIER J M,SAKLES J C,STOLZ U,et al.Neuromuscular blockade improves first-attempt success for intubation in the intensive care unit:apropensity matched analysis[J].Ann Am Thorac Soc,2015,12(5):734-741.
• [23]DE JONG A,MOLINARI N,CONSEIL M,et al.Video laryngoscopy versus direct laryngoscopy for orotracheal intubation in the intensive care unit:a systematic review and meta-analysis[J].Intensive Care Med,2014,40(5):629-639.
• [24]HYPES C D,STOLZ U,SAKLES J C,et al.Video laryngoscopy improves odds of first attempt success at intubation in the ICU:apropensity-matched analysis[J].Ann Am Thorac Soc,2016,13(3):382-390.
• [25]JABER S,JUNG B,CORNE P,et al.An intervention to decrease complications related to endotracheal intubation in the intensive care unit:aprospective,multiple-center study[J].Intensive Care Med,2010,36(2):248-255.
• [26]CHRIMES N C.The vortex:striving for simplicity,context independence and teamwork in an airway cognitive tool[J].Br J Anaesth,2015,115(1):148-149.