Paper Example on Emergency Airway Management: Challenges & Solutions

Patients who require emergency airway management are always at higher risk of acute hypoxemic events. They generally encounter health issues due to underlying high metabolic demands, lung pathology, inability to protect the airway against aspiration, and insufficient respiratory drive. According to (Chua et al. 2019 p.195) critically ill patients require emergency tracheal intubation. Rapid sequencing of intubation ensures the unresponsiveness and muscular relaxation as the airway is managed of acute compromise. Boccatonda and Groff in their findings opined that during rapid sequencing intubation, the state and functionality of the trachea should be assessed with the use of procedural hypoxia (Boccatonda and Groff, 2019 p.12). As such, during pre-oxygenation, there is the need to administer high-flow nasal oxygen for maintenance of the alveoli functionality (Farmery and Roe, 1996 p. 290).

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According to Gupta et al, rapid sequence intubation (RSI) remains the commonest and safe method of airway control in the emergency department (Gupta et al., 2016 p. 320). During the management of the airway, the anesthetic agent is administered alongside a neurotransmitter substance to optimize the tracheal conditions. Masclans et al., argue that pre-oxygenation, however, must be among the first management as it forms an important step in maximizing the safety of rapid sequence intubation (Masclans et al., 2019 p 290).

As a matter of concern, Natt et al., weighed in by asserting how essential airway management is to a critically ill patient (Natt et al., 2016 p.62). As such, he opined that preoxygenation must be performed to increase oxygen reserve. The levels of oxygen as opined by Nishimura M. (2016 p. 530 ) prevent hypoxemia during apnea. Pre-oxygenation and apneic oxygenation thus are beneficial when manual ventilation is carried.

According to Silva et al., the primary purpose of preoxygenation is to “denitrogenize” the lungs by filling the compartments such as arteries, alveoli, tissues and veins with oxygen especially to extend safe apnea time. However, Pavlov, Medrano and Weingart (2017 p. 1185) in his research on how to extend apnea time, suggested that the cessation of breathing during critical arterial intubation can present many clinical effects if the lungs are not desaturated first. Pourmand et al., (2017 p. 1177) articulated how effective is preoxygenation in his work “physiology of apnea and the benefits of preoxygenation”. He opined that preoxygenation replaces nitrogen in the FRC with oxygen resulting in storage of oxygen in the tissues, thus an increase in the tolerance of apnea.

In a prehospital environment, the use of AIRVO 2 is critical. This is the use of an integrated generator to deliver a high flow of warmed and humidified respiratory gases to critically ill patients with spontaneous breathing through different patient interfaces (Russotto et al., 2017 p. 100). According to Masclans et al., (2019 p. 290) the use of Airvo 2ensures that safe apnoeic time is achieved for clearance and management of the airway. Research shows that the use of Airvo 2 (HFNOT) is far much important then LFNOT because it guarantees “safe pre and apnoeic time”.

In 2012, research on oximetry during its infancy revealed how quick hypoxemic events unfolded shortly after intubation in fit and health patients. The hypoxemic conditions, however, are attributed to the induction of anesthesia when preoxygenation was not performed.

Conclusion

In conclusion, (Russotto et al., 137) suggested that there is a need to alter the current practice and routines during pre and apnoeic oxygenation for rapid sequence intubation (RIS) in emergency departments (ED). However, many pieces of research intimate that pre and apneic oxygenation present a simple means besides being a low-cost intervention to be used in emergency departments. The brief period in which oxygen is administered is unlikely to cause any harm to patients when care is taken.

References

Chua, M.T., Khan, F.A., Ng, W.M., Lu, Q., Low, M.J.W., Yau, Y.W., Punyadasa, A. and Kuan, W.S., 2019. Pre-and Apnoeic high flow oxygenation for RApid sequence intubation in The Emergency department (Pre-AeRATE): study protocol for a multicentre, randomised controlled trial. Trials, 20(1), p.195.

Boccatonda, A. and Groff, P., 2019. High-flow nasal cannula oxygenation utilization in respiratory failure. European journal of internal medicine, 64, pp.10-14.

Farmery, A.D. and Roe, P.G., 1996. A model to describe the rate of oxyhaemoglobin desaturation during apnoea. British journal of anaesthesia, 76(2), pp.284-291.

Gupta, K.K., Attri, J.P., Singh, A., Kaur, H. and Kaur, G., 2016. Basic concepts for sample size calculation: Critical step for any clinical trials!. Saudi journal of anaesthesia, 10(3), p.328.

Masclans, J.R., Dot, I. and Pérez-Teran, P., 2019. High-Flow Nasal Cannulae. The Quest for the Holy Grail in the Critical Respiratory Patient?. Archivos de bronconeumologia, 55(6), p.291.

Natt, B.S., Malo, J., Hypes, C.D., Sakles, J.C. and Mosier, J.M., 2016. Strategies to improve first attempt success at intubation in critically ill patients. BJA: British Journal of Anaesthesia, 117(suppl_1), pp.i60-i68.

Nishimura, M., 2016. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respiratory care, 61(4), pp.529-541.

Silva, L.O.J., Cabrera, D., Barrionuevo, P., Johnson, R.L., Erwin, P.J., Murad, M.H. and Bellolio, M.F., 2017. Effectiveness of apneic oxygenation during intubation: a systematic review and meta-analysis. Annals of emergency medicine, 70(4), pp.483-494.

Pavlov, I., Medrano, S. and Weingart, S., 2017. Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis. The American journal of emergency medicine, 35(8), pp.1184-1189.

Pourmand, A., Robinson, C., Dorwart, K. and O'Connell, F., 2017. Pre-oxygenation: implications in emergency airway management. The American journal of emergency medicine, 35(8), pp.1177-1183.

Russotto, V., Cortegiani, A., Raineri, S.M., Gregoretti, C. and Giarratano, A., 2017. Respiratory support techniques to avoid desaturation in critically ill patients requiring endotracheal intubation: a systematic review and meta-analysis. Journal of Critical Care, 41, pp.98-106.