Letter to the Editor
Airway management in intensive care units
Manejo de la vía aérea en las unidades de cuidados intensivos
a Departamento de Anestesiología y Medicina Perioperatoria, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
b Departamento de Anestesiologia, Hospital HM Modelo, A Coruña, Spain
c Grupo de Anestesiología y Tratamiento del Dolor, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
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Other contributing factors are the absence of pre-established strategies (protocols, absent in up to 77% of the ICUs surveyed) and sub-optimal training. Clinical guidelines and algorithms have changed the medical practice and stimulated the culture of “planning” and they are used as cognitive support in critical situations to increase the level of safety.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> We should say here that the DAS has recently published a clinical guideline/specific algorithm for the AM of critically ill patients that will surely become a reference tool.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> The prior assessment of the airway (absent in 22.8%) is indicated even in the most urgent situations.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> We are lacking the use of the MACOCHA score in the survey though – the only one that has been validated in critical care settings. Similarly, it seems undeniable that there is this need for continuous medical training (53.5%) in technical and non-technical skills (team work, leadership or the right progression of the interventions) and in the simulation of unexpected and unusual scenarios.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regardless of the existing heterogeneity in the devices selected for AM among different institutions, today it is recommended to have one device for primary use available plus one alternative only in order to avoid cognitive overload and facilitate the decision-making process. The actual recommendations indicate that video laryngoscopes (53.5%) and second-generation laryngeal masks (%?) should be available wherever AM is a common practice.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">4,5</span></a> It is surprising to see that angulated-blade video laryngoscopes are everybody's choice to the detriment of standard-blade video laryngoscopes. There is evidence that the use of the former (GlideScope<span class="elsevierStyleSup">®</span> and McGrath<span class="elsevierStyleSup">®</span> MAC) in critical care may increase morbimortality though.</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is also striking to see that the use of capnography has not been assessed given it is responsible for over 70% of all deaths in the ICU setting<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> and its universal implementation in ICUs has been considered the only change that is powerful enough to avoid mortality.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> This is so because it allows us to diagnose early failed intubations and accidental displacements of cannulas and endotracheal tubes.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We need a major overhaul to match the actual practice to the actual recommendations. As professionals from different fields of expertise we have the possibility of meeting Bromiley's request<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> of managing airways safe and securely. Articles such as this one conducted by Gómez-Prieto et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> are key if we really want to make a change.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez-Ríos MA. Manejo de la vía aérea en las unidades de cuidados intensivos. Med Intensiva. 2019;43:185–186.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Encuesta nacional sobre el manejo de la vía aérea y la vía aérea difícil en las unidades de cuidados intensivos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.G. Gómez-Prieto" 1 => "M.R. Miguez-Crespo" 2 => "J.R. Jiménez-del-Valle" 3 => "M.D. González-Caro" 4 => "I. Marmesat-Rios" 5 => "J. 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Bromiley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ Qual Saf" "fecha" => "2015" "volumen" => "24" "paginaInicial" => "425" "paginaFinal" => "427" "itemHostRev" => array:3 [ "pii" => "S2213219816305645" "estado" => "S300" "issn" => "22132198" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004300000003/v1_201903300628/S2173572719300207/v1_201903300628/en/main.assets" "Apartado" => array:4 [ "identificador" => "64604" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004300000003/v1_201903300628/S2173572719300207/v1_201903300628/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572719300207?idApp=WMIE" ]
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