- In this article, the authors review the difficulties and dangers of non-OR airway management, and how the use of Point-of-care ultrasound (POCUS) can assist the anesthesia professional in managing these patients.
- A previous article that reviewed the intubation of 2964 critically ill patients found that 42.6% exhibited hemodynamic instability, 9.3% were severely hypoxic, and 3.1% suffered a cardiac arrest.
- The authors believe that the use of POCUS can provide the clinician with valuable information about the patient’s condition that can mitigate the physiologic derangements that occur with intubation. The clinician could then initiate measures to decrease the severity of these problems.
- Specifically, POCUS can be used to screen for factors that could lead to cardiovascular collapse during intubation, such as decreased LV contractility, pericardial effusion, or a dilated RV.
- POCUS can also be used to evaluate intravascular volume status, and screen for vascular abnormalities such as an aortic aneurysm.
- Ultrasound can detect lung consolidation or pneumothorax which could lead to significant oxygen desaturation during intubation.
- Given that many of these patients have an uncertain fasting status, gastric ultrasound emerges as a valuable tool for assessing gastric volume.
- Finally, an adequate airway evaluation may be difficult or impossible in these patients. POCUS can help identify and predict an anatomically difficult airway.
- It is clear that non-OR intubations in emergency situations frequently occur in critically ill patients who are hemodynamically and physiologically unstable. POCUS can provide the clinician with valuable physiologic data to help them in determining the best and safest method to intubate these patients.
Summary of "Role of Point-of-Care Ultrasound in Emergency Airway Management Outside the Operating Room"
Summary published October 31, 2023