Zusammenfassung
Etwa 20% aller Atemwegssicherungen auf der Intensivstation werden als schwierig beschrieben. Die eingeschränkte physiologische Reserve des Intensivpatienten in der oft dringlichen Situation, die räumliche Enge und die Inhomogenität der ärztlichen Besetzung stellen wesentliche Unterschiede gegenüber der Atemwegssicherung im OP dar. Dieser Beitrag gibt einen Überblick über diese Besonderheiten und skizziert eine mögliche Herangehensweise.
Abstract
Problems with airway management occur more frequently in the critical care setting than in the operating room. Early detection of a possibly difficult airway can be accomplished by performing few simple tests. When securing the airway, the first-pass success reduces complications. Ventilation via facemask and supraglottic airways, as well as endotracheal intubation via direct and indirect laryngoscopy are essential skills. Adequate neuromuscular block will help in intubation and ventilation. In case of “cannot-ventilate-cannot-oxygenate” situations, front-of-neck airway access should be used early. Capnography should be used for confirmation of endotracheal intubation and verifying the effectiveness of ventilation. After securing a difficult airway, precautions should be made for possible accidental extubation. The team caring for a patient with a difficult airway should be aware of the specific problems. Depth of tracheal tube insertion should be monitored once per shift along with cuff pressures. Regular suction can check for patency of the endotracheal tube. Team management skills can help improve the outcome, especially in difficult airways.
Schlüsselwörter
Intensivmedizin - Atemwegsmanagement - schwieriger Atemweg
Key words
critical care - airway management - difficult airway
