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Sharing today Extubation of Difficult Airway Patients--Focus on Patients' Prognosis After the release of the guidelines for difficult airway, the compensation for airway injury during induction was significantly reduced, and the compensation for extubation airway remained unchanged
.
• Removal of the endotracheal tube is a step-by-step selection process and should be considered incrementally
.
Procedure: Follow evidence-based extubation criteria to determine the underlying cause of extubation failure and decide whether to extubate awake or under deep anesthesia
.
(Difficult airway, risk of aspiration, poor basic awareness, obese patients are not suitable for deep anesthesia and extubation) Pre-planned reintubation after extubation failure The team communicated closely and established a plan to guide the timing of extubation after complex surgery
.
Bronchoscopy was performed after extubation to ensure that the throat edema was resolved
.
General criteria for extubation: the patient is awake and cooperative; hemodynamically stable on the basis of no or minimal vasoconstrictor use; no bleeding or coagulation; Negative air pressure>30cmH2o Shallow fast breathing index frequency/tidal volume<100 chemical standard PH>7.
25 Pao2/Fio2>300 Fio2>0.
4 pao2>65mmhg Minimum PEEP 5-8cmh2o Acceptable Paco2<50 mmhg Stable metabolic state Hco3>20mmhg Risk factors for failure of extubation Pharyngeal obstruction: back tongue, decreased tidal volume, reduced cough intensity, secretion accumulation, retropharyngeal hematoma (anterior cervical surgery) Airway obstruction: laryngeal edema, laryngospasm, vocal cord paralysis, trachea Softening of the lungs Causes: Pulmonary edema (cardiogenic pulmonary edema, non-cardiogenic negative pressure pulmonary edema), atelectasis, pneumothorax, pneumonia, ARDS bleeding or mass lesions: External or internal hematoma/bleeding compressing or obstructing the airway , or there is airway, retrosternal and mediastinal mass, cuff leak test CLT deflates through the ETT balloon, blocking its opening, and listens to whether there is air leakage around the ETT during spontaneous breathing.
CLT is higher than a certain threshold and greater than inspiratory VT15% Or more than 140ml patients with lower probability of stridor after extubation, with high specificity and negative predictive value
.
Airway management steps for patients with failed extubation (including patients with cervical hematoma) Multidisciplinary collaboration to ensure that airway management equipment (oxygen source, suction device, exchange tube AEC, oropharyngeal nasopharyngeal airway, acoustic On-door devices, endotracheal tubes of different sizes, various laryngoscopes and fiberoptic bronchoscopes, jet ventilation and cricothyrotomy kits) resuscitation and induction drugs ASA monitoring, including capnography, context-specific extubation strategies for extubation, Such as airway surgery, neck surgery, maxillofacial surgery
.
Postoperative management of neck hematoma First press the bleeding site Notify the surgical and anesthesiologist team (seek help) Consider reversal of residual anticoagulation Tight blood pressure control Follow up based on results A Hematoma does not expand further, mark borders, close observation B Hematoma Continuous expansion, no airway compression, should be awake and intubated after local anesthesia, and then under general anesthesia, neck hematoma exploration and drainage, postoperative assessment of neurological status, retention of tracheal tube until reactive airway edema disappears C Hematoma continues to expand and quickly Airway compression occurs · Ventilation is possible but cannot be intubated: mask, oropharyngeal, laryngeal mask · Consider immediate neck hematoma drainage before further attempts to establish a stable airway · Unable to intubate, unable to ventilate · Establish surgical airway (emergency cricothyroid membrane) Incision, percutaneous or surgical tracheostomy) Hematoma removal and wound exploration Neurological assessment Postoperative airway safety END Anesthesia guidelines and expert consensus learning day7 Anesthesia guidelines and expert consensus learning of difficult airway management guidelines day8 New progress in difficult airway management Professor Zuo Mingzhang's anesthesia guidelines and expert consensus study day9 Airway management in thoracic surgery Professor Zhang Huan's anesthesia guidelines and expert consensus study day10 Difficult airway update Beijing Anesthesia Annual Meeting Airway Workshop Unexpected difficult airway ? Difficulty with mask ventilation? How to choose a muscle relaxation strategy? Pediatric Anesthesia Airway and Respiratory Management Guidelines (2017 Edition) reprint is a kind of motivation sharing is a virtue
.
Sharing today Extubation of Difficult Airway Patients--Focus on Patients' Prognosis After the release of the guidelines for difficult airway, the compensation for airway injury during induction was significantly reduced, and the compensation for extubation airway remained unchanged
.
• Removal of the endotracheal tube is a step-by-step selection process and should be considered incrementally
.
Procedure: Follow evidence-based extubation criteria to determine the underlying cause of extubation failure and decide whether to extubate awake or under deep anesthesia
.
(Difficult airway, risk of aspiration, poor basic awareness, obese patients are not suitable for deep anesthesia and extubation) Pre-planned reintubation after extubation failure The team communicated closely and established a plan to guide the timing of extubation after complex surgery
.
Bronchoscopy was performed after extubation to ensure that the throat edema was resolved
.
General criteria for extubation: the patient is awake and cooperative; hemodynamically stable on the basis of no or minimal vasoconstrictor use; no bleeding or coagulation; Negative air pressure>30cmH2o Shallow fast breathing index frequency/tidal volume<100 chemical standard PH>7.
25 Pao2/Fio2>300 Fio2>0.
4 pao2>65mmhg Minimum PEEP 5-8cmh2o Acceptable Paco2<50 mmhg Stable metabolic state Hco3>20mmhg Risk factors for failure of extubation Pharyngeal obstruction: back tongue, decreased tidal volume, reduced cough intensity, secretion accumulation, retropharyngeal hematoma (anterior cervical surgery) Airway obstruction: laryngeal edema, laryngospasm, vocal cord paralysis, trachea Softening of the lungs Causes: Pulmonary edema (cardiogenic pulmonary edema, non-cardiogenic negative pressure pulmonary edema), atelectasis, pneumothorax, pneumonia, ARDS bleeding or mass lesions: External or internal hematoma/bleeding compressing or obstructing the airway , or there is airway, retrosternal and mediastinal mass, cuff leak test CLT deflates through the ETT balloon, blocking its opening, and listens to whether there is air leakage around the ETT during spontaneous breathing.
CLT is higher than a certain threshold and greater than inspiratory VT15% Or more than 140ml patients with lower probability of stridor after extubation, with high specificity and negative predictive value
.
Airway management steps for patients with failed extubation (including patients with cervical hematoma) Multidisciplinary collaboration to ensure that airway management equipment (oxygen source, suction device, exchange tube AEC, oropharyngeal nasopharyngeal airway, acoustic On-door devices, endotracheal tubes of different sizes, various laryngoscopes and fiberoptic bronchoscopes, jet ventilation and cricothyrotomy kits) resuscitation and induction drugs ASA monitoring, including capnography, context-specific extubation strategies for extubation, Such as airway surgery, neck surgery, maxillofacial surgery
.
Postoperative management of neck hematoma First press the bleeding site Notify the surgical and anesthesiologist team (seek help) Consider reversal of residual anticoagulation Tight blood pressure control Follow up based on results A Hematoma does not expand further, mark borders, close observation B Hematoma Continuous expansion, no airway compression, should be awake and intubated after local anesthesia, and then under general anesthesia, neck hematoma exploration and drainage, postoperative assessment of neurological status, retention of tracheal tube until reactive airway edema disappears C Hematoma continues to expand and quickly Airway compression occurs · Ventilation is possible but cannot be intubated: mask, oropharyngeal, laryngeal mask · Consider immediate neck hematoma drainage before further attempts to establish a stable airway · Unable to intubate, unable to ventilate · Establish surgical airway (emergency cricothyroid membrane) Incision, percutaneous or surgical tracheostomy) Hematoma removal and wound exploration Neurological assessment Postoperative airway safety END Anesthesia guidelines and expert consensus learning day7 Anesthesia guidelines and expert consensus learning of difficult airway management guidelines day8 New progress in difficult airway management Professor Zuo Mingzhang's anesthesia guidelines and expert consensus study day9 Airway management in thoracic surgery Professor Zhang Huan's anesthesia guidelines and expert consensus study day10 Difficult airway update Beijing Anesthesia Annual Meeting Airway Workshop Unexpected difficult airway ? Difficulty with mask ventilation? How to choose a muscle relaxation strategy? Pediatric Anesthesia Airway and Respiratory Management Guidelines (2017 Edition) reprint is a kind of motivation sharing is a virtue
