What is airway management?
Airway management may be required when a patient has a lowered level of consciousness, is anaesthetised or when the patient’s airway is otherwise inadequate i.e. obstructed. Airway management is a set of maneuverers and medical procedures performed to help provide an adequate, functioning Airway.
Commonly we can categorise airway management into essential or advanced. Essential techniques are minimally invasive and usually only require simple medical equipment and training. Techniques included head and neck manoeuvres to optimise ventilation, Simple adjuncts such as Nasopharyngeal and Oropharyngeal, Bag-Mask Ventilation and back blows and/or abdominal thrusts for choking.
Advanced techniques require specialised training and equipment and can be broken down into anatomical categories as Extraglottic devices (Subdivided into Supraglottic and Retroglottic) Endo-tracheal intubation and the surgical methods of cricothyrotomy and tracheotomy.
Airway management is used in a variety of cases such as cardiopulmonary resuscitations, anaesthesia, emergency medicine, intensive care medicine and Pre-Hospital.
Extraglottic Techniques
The most common group are Supraglottic airway devices aka SADs and these are used to keep the upper airway open to provide unobstructed ventilation without the need for endotracheal intubation. SADs is most commonly used in the operating theatre, the most common devices are variations of the laryngeal mask airways (LMAs) and similar devices such as the i-gel. Over the years the use of SADs has grown substantially, making them more likely to be used in many clinical environments.
Tracheal Intubation Techniques
Unlike supraglottic airway devices, endotracheal intubation devices create a sealed conduit between the mouth, passing through the glottis and into the trachea. There are various methods and devices that can be used, and the chosen technique is dependent on accessibility, the competence of the clinician and the patient’s condition. Intubation is the placement of a flexible tube into the trachea to maintain an open airway. The most common method is orotracheal in which an endotracheal tube (aka ET tube) is passed through the mouth, this can be completed by using a laryngoscope to hold the patient’s mouth open, an introducer (Either Stylet or Bougie) to guide through to the trachea and then followed by an ET tube.
Surgical Methods
Often used as a last resort surgical airway management is often used when other techniques are unsuitable, i.e. the airway is blocked by a foreign object which can’t be dislodged or facial trauma and in some cases when a patient needs mechanical ventilation for a long period of time. There are two types of surgery a cricothyrotomy is an emergency surgical procedure in which either a needle or preferably an incision is made through the cricothyroid membrane and a small ET tube is inserted or a tracheotomy is where a specialist surgeon makes incision lower in the neck and a bespoke airway catheter is inserted directly into the trachea.