危重患者困難氣道管理策略_Chinese Journal of Respiratory and Critical Care Medicine

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何征宇 , 王祥瑞

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危重患者; 氣道管理

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氣道管理是危重患者救治過程中最重要的操作技術, 而危重患者進行氣管插管操作時心肺功能和內環境往往處于失代償狀態, 對缺氧的耐受性明顯降低, 易發生誤吸及心搏驟停等嚴重并發癥[ 1] 。因此, 完善對危重患者困難氣道的管理策略, 掌握熟練的氣道開放技術, 對于提高危重患者搶救成功率, 降低并發癥發生率和死亡率具有重要意義。

Citation： 何征宇,王祥瑞. 危重患者困難氣道管理策略. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(2): 220-222. doi: Copy

1.	Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: A prospective, multiple-center study. Critical Care Medicine, 2006 , 34 : 2355-2361.
2.	Koh LK, Kong CE, Ip-Yam PC. The modified Cormack-Lehane score for the grading of direct laryngoscopy: evaluation in the Asian population. Anaesth Intensive Care, 2002, 30: 48 -51 .
3.	Yildiz TS, Solak M, Toker K. The incidence and risk factors of difficult mask ventilation. J Anesth, 2005, 19: 7-11.
4.	Langeron O, Masso E, Huraux C, et al. Prediction of difficult mask ventilation. Anesthesiology, 2000, 92 : 1229 -1236 .
5.	Murphy M, WilliamsW. Manual of emergency airway management. IL: Lippincott, 2000 .
6.	Reed MJ, Dunn MJG, McKeown DW. Can an airway assessment score predict difficulty at intubation in the emergency department?Emerg Med J, 2005, 22: 99-102.
7.	Cobley M, Vaughan RS. Recognition and management of difficult airway problems. Br J Anaesth, 1992 , 68: 90-97.
8.	Christie JM, Dethlefsen M, Cane RD. Unplanned endotracheal extubation in the intensive care unit. J Clini Anesth,1996,8:289-293.
9.	Adnet F, Borron SW, Dumas JL, et al. Study of the “sniffing position” by magnetic resonance imaging. Anesthesiology, 2001 ,94: 83-86 .
10.	Adnet F, Baillard C, Borron SW, et al. Randomized study comparing the “sniffing position“with simple head extension for laryngoscopic view in elective surgery patients. Anesthesiology,2001, 95: 836-841.
11.	Mort TC. Preoxygenation in critically ill patients requiring emergency tracheal intubation. Criti Care Med, 2005, 33: 2672-2675.
12.	Baillard C, Fosse JP, Sebbane M, et al. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. AmJ Respir Criti Care Med, 2006 , 174: 171-177 .
13.	Lippmann M, Kakazu C. Hemodynamics with propofol: Is propofol dangerous in classes III-V patients? Anesth Analg, 2006, 103 : 260.
14.	Zed PJ, Abu-Laban RB, Harrison DW. Intubating conditions and hemodynamic effects of etomidate for rapid sequence intubation in the emergency department: An observational cohort study. Acad Emerg Med, 2006, 13: 378-383 .
15.	Mokhlesi B. Corticosteroids for patients with septic shock. JAMA,2003, 289: 43, author reply 43 -44.
16.	Bloomfield R, Noble DW. Etomidate and fatal outcome - even a single bolus dose may be detrimental for some patients. Br J of Anaesth, 2006, 97: 116 -117.
17.	Martin E, Ramsay G, Mantz J, et al. The role of the alpha2 -adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med, 2003 , 18 : 29-41.
18.	Hsu YW, Cortinez LI, Robertson KM, et al. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers.Anesthesiology, 2004, 101 : 1066-1076.
19.	Avitsian R, Lin J, Lotto M, et al. Dexmedetomidine and awake fiberoptic intubation for possible cervical spine myelopathy -a clinical series. J Neurosurg Anesthesiol, 2005, 17: 97 -99 .
20.	Leykin Y, Pellis T, Lucca M, et al. Intubation conditions following rocuronium: influence of induction agent and priming. Anaesth Intensive Care, 2005, 33 : 462-468.
21.	Ledowski T, Wulf H. The influence of fentanyl vs. s-ketamine on intubating conditions during induction of anaesthesia with etomidateand rocuronium. Eur J Anaesthesiol, 2001, 18 : 519-523.
22.	Hughes M, Grant IS, Biccard B, et al. Suxamethonium and critical illness polyneuropathy. Anaesth Intensive Care, 1999, 27: 636-638 .
23.	Sluga M, Ummenhofer W, Studer W, et al. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases. Anesth Analg, 2005, 101: 1356-1361.
24.	Mencke T, Knoll H, Schreiber JU, et al. Rocuronium is not associated with more vocal cord injuries than succinylcholine after rapid-sequence induction: a randomized, prospective, controlled trial. Anesth Analg, 2006 , 102: 943-949.
25.	Divatia JV, Kulkarni AP, Sindhkar S, et al. Failed intubation in the intensive care unit managed with laryngeal mask airway and percutaneous tracheostomy. Anaesth Intensive Care,1999,27:409-411.
26.	Ferson DZ, Rosenblatt WH, Johansen MJ, et al. Use of the Intubating LMA-Fastrach in 254 patients with difficult-to-manage airways. Anesthesiology, 2001, 95: 1175-1181.
27.	Frappier J, Guenoun T, Journois D, et al. Airway management using the intubating laryngeal mask airway for the morbidly obese patient.Anesth Analg, 2003, 96: 1510-1515.
28.	Goldman AJ, Rosenblatt WH. Use of the fibreoptic intubating LMACTrach ( TM) in two patients with difficult airways. Anaesthesia,2006, 61: 601-603 .
29.	Noguchi T, Koga K, Shiga Y, et al. The gum elastic bougie eases tracheal intubation while applying cricoid pressure compared to a stylet. Can J Anesth, 2003, 50: 712-717 .
30.	Yardy N, Hancox D, Strang T. A comparison of two airway aids for emergency use by unskilled personnel: The Combitube and laryngeal mask. Anaesthesia, 1999 , 54: 181-183.
31.	Ault MJ, Ault B, Ng PK. Percutaneous dilatational tracheostomy for emergent airway access. J Intensive Care Med, 2003, 18: 222-226.
32.	Polderman KH, Spijkstra JJ, de Bree R, et al. Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication. Chest,2003, 123: 1595-1602.
33.	俞森洋. 有創機械通氣患者人工氣道的選擇: 經鼻還是經口插管.是否要早做氣管切開. 中國呼吸與危重監護雜志, 2009,8:3-5.

1. Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: A prospective, multiple-center study. Critical Care Medicine, 2006 , 34 : 2355-2361.
2. Koh LK, Kong CE, Ip-Yam PC. The modified Cormack-Lehane score for the grading of direct laryngoscopy: evaluation in the Asian population. Anaesth Intensive Care, 2002, 30: 48 -51 .
3. Yildiz TS, Solak M, Toker K. The incidence and risk factors of difficult mask ventilation. J Anesth, 2005, 19: 7-11.
4. Langeron O, Masso E, Huraux C, et al. Prediction of difficult mask ventilation. Anesthesiology, 2000, 92 : 1229 -1236 .
5. Murphy M, WilliamsW. Manual of emergency airway management. IL: Lippincott, 2000 .
6. Reed MJ, Dunn MJG, McKeown DW. Can an airway assessment score predict difficulty at intubation in the emergency department?Emerg Med J, 2005, 22: 99-102.
7. Cobley M, Vaughan RS. Recognition and management of difficult airway problems. Br J Anaesth, 1992 , 68: 90-97.
8. Christie JM, Dethlefsen M, Cane RD. Unplanned endotracheal extubation in the intensive care unit. J Clini Anesth,1996,8:289-293.
9. Adnet F, Borron SW, Dumas JL, et al. Study of the “sniffing position” by magnetic resonance imaging. Anesthesiology, 2001 ,94: 83-86 .
10. Adnet F, Baillard C, Borron SW, et al. Randomized study comparing the “sniffing position“with simple head extension for laryngoscopic view in elective surgery patients. Anesthesiology,2001, 95: 836-841.
11. Mort TC. Preoxygenation in critically ill patients requiring emergency tracheal intubation. Criti Care Med, 2005, 33: 2672-2675.
12. Baillard C, Fosse JP, Sebbane M, et al. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. AmJ Respir Criti Care Med, 2006 , 174: 171-177 .
13. Lippmann M, Kakazu C. Hemodynamics with propofol: Is propofol dangerous in classes III-V patients? Anesth Analg, 2006, 103 : 260.
14. Zed PJ, Abu-Laban RB, Harrison DW. Intubating conditions and hemodynamic effects of etomidate for rapid sequence intubation in the emergency department: An observational cohort study. Acad Emerg Med, 2006, 13: 378-383 .
15. Mokhlesi B. Corticosteroids for patients with septic shock. JAMA,2003, 289: 43, author reply 43 -44.
16. Bloomfield R, Noble DW. Etomidate and fatal outcome - even a single bolus dose may be detrimental for some patients. Br J of Anaesth, 2006, 97: 116 -117.
17. Martin E, Ramsay G, Mantz J, et al. The role of the alpha2 -adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med, 2003 , 18 : 29-41.
18. Hsu YW, Cortinez LI, Robertson KM, et al. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers.Anesthesiology, 2004, 101 : 1066-1076.
19. Avitsian R, Lin J, Lotto M, et al. Dexmedetomidine and awake fiberoptic intubation for possible cervical spine myelopathy -a clinical series. J Neurosurg Anesthesiol, 2005, 17: 97 -99 .
20. Leykin Y, Pellis T, Lucca M, et al. Intubation conditions following rocuronium: influence of induction agent and priming. Anaesth Intensive Care, 2005, 33 : 462-468.
21. Ledowski T, Wulf H. The influence of fentanyl vs. s-ketamine on intubating conditions during induction of anaesthesia with etomidateand rocuronium. Eur J Anaesthesiol, 2001, 18 : 519-523.
22. Hughes M, Grant IS, Biccard B, et al. Suxamethonium and critical illness polyneuropathy. Anaesth Intensive Care, 1999, 27: 636-638 .
23. Sluga M, Ummenhofer W, Studer W, et al. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases. Anesth Analg, 2005, 101: 1356-1361.
24. Mencke T, Knoll H, Schreiber JU, et al. Rocuronium is not associated with more vocal cord injuries than succinylcholine after rapid-sequence induction: a randomized, prospective, controlled trial. Anesth Analg, 2006 , 102: 943-949.
25. Divatia JV, Kulkarni AP, Sindhkar S, et al. Failed intubation in the intensive care unit managed with laryngeal mask airway and percutaneous tracheostomy. Anaesth Intensive Care,1999,27:409-411.
26. Ferson DZ, Rosenblatt WH, Johansen MJ, et al. Use of the Intubating LMA-Fastrach in 254 patients with difficult-to-manage airways. Anesthesiology, 2001, 95: 1175-1181.
27. Frappier J, Guenoun T, Journois D, et al. Airway management using the intubating laryngeal mask airway for the morbidly obese patient.Anesth Analg, 2003, 96: 1510-1515.
28. Goldman AJ, Rosenblatt WH. Use of the fibreoptic intubating LMACTrach ( TM) in two patients with difficult airways. Anaesthesia,2006, 61: 601-603 .
29. Noguchi T, Koga K, Shiga Y, et al. The gum elastic bougie eases tracheal intubation while applying cricoid pressure compared to a stylet. Can J Anesth, 2003, 50: 712-717 .
30. Yardy N, Hancox D, Strang T. A comparison of two airway aids for emergency use by unskilled personnel: The Combitube and laryngeal mask. Anaesthesia, 1999 , 54: 181-183.
31. Ault MJ, Ault B, Ng PK. Percutaneous dilatational tracheostomy for emergent airway access. J Intensive Care Med, 2003, 18: 222-226.
32. Polderman KH, Spijkstra JJ, de Bree R, et al. Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication. Chest,2003, 123: 1595-1602.
33. 俞森洋. 有創機械通氣患者人工氣道的選擇: 經鼻還是經口插管.是否要早做氣管切開. 中國呼吸與危重監護雜志, 2009,8:3-5.

Chinese Journal of Respiratory and Critical Care Medicine

危重患者困難氣道管理策略

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