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Chapter 19 - Multimodal Techniques for Airway Management

from Section 1 - Airway Management: Background and Techniques

Published online by Cambridge University Press:  03 October 2020

Tim Cook
Affiliation:
Royal United Hospital, Bath, UK
Michael Seltz Kristensen
Affiliation:
Rigshospitalet, Copenhagen University Hospital, Denmark
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Summary

As opposed to the simplistic promotion of one given technique or device, the multimodal airway management relies on the recognition that each individual approach may fail, that the maintenance of oxygenation during the procedure is a key point, that the prerequisites to the practical step of placing a tube in the trachea involve the knowledge of intelligent and intelligible algorithms and the previous acquisition of skills, with understanding of their foundations. An example of the ‘combination techniques’ using the specific advantages of one medical device to mitigate the limitations of another is the use of a videolaryngoscope to facilitate intubation with a flexible optical bronchoscope, which increases the ease and the success of the process during the clinical as well as the training phases. Other multimodal approaches such as the combination of bronchoscopy with the use of a supraglottic airway or with high flow nasal oxygen optimise the safety of the procedure by maintaining the delivery of oxygen. The multimodal approach is particularly useful for the anaesthesiologist and intensivist only occasionally exposed to the management of difficult airway situations. It improves high quality care of patients, education and training.

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Publisher: Cambridge University Press
Print publication year: 2020

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References

Further Reading

Boet, S, Bould, MD, Schaeffer, R, et al. (2010). Learning fibreoptic intubation with a virtual computer program transfers to ‘hands on’ improvement. European Journal of Anaesthesiology, 27, 3135.CrossRefGoogle ScholarPubMed
Giglioli, S, Boet, S, De Gaudio, AR, et al. (2012). Self-directed deliberate practice with virtual fiberoptic intubation improves initial skills for anesthesia residents. Minerva Anestesiologica, 78, 456461.Google Scholar
Gil, K, Diemunsch, P. (2018). Flexible scope intubation techniques. In: Hagberg, CA, Artime, CA, Aziz, MF (Eds.), Hagberg and Benumof’s Airway Management. 4th ed. Philadelphia: Elsevier. pp. 428470.Google Scholar
Greib, N, Stojeba, N, Dow, WA, Henderson, J, Diemunsch, PA. (2007). A combined rigid videolaryngoscopy-flexible fibrescopy intubation technique under general anesthesia. Canadian Journal of Anaesthesia, 54, 492493.Google Scholar
Higgs, A, McGrath, BA, Goddard, C, et al.; Difficult Airway Society; Intensive Care Society; Faculty of Intensive Care Medicine; Royal College of Anaesthetists. (2018). Guidelines for the management of tracheal intubation in critically ill adults. British Journal of Anaesthesia, 120, 323352.Google Scholar
Lenhardt, R, Burkhart, MT, Brock, GN, et al. (2014). Is video laryngoscope-assisted flexible tracheoscope intubation feasible for patients with predicted difficult airway? A prospective, randomized clinical trial. Anesthesia & Analgesia, 118, 12591265.Google Scholar
Quintard, H, l’Her, E, Pottecher, J, et al. (2017). Intubation and extubation of the ICU patient. Anaesthesia Critical Care & Pain Medicine, 36, 327341.CrossRefGoogle ScholarPubMed
Vlassakov, K. (2016). Multimodal airway management: combining advanced airway techniques can be better. Anesthesiology News Airway Management, 13, 5359.Google Scholar

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