Airway management in patients with suspected or confirmed cervical spine injury

医学 气道管理 气道 插管 气管插管 脊髓损伤 系统回顾 重症监护医学 颈椎损伤 颈椎 梅德林 麻醉 外科 脊髓 精神科 政治学 法学
作者
M. D. Wiles,H. A. Iliff,Katherine Brooks,E. J. Da Silva,Mike Donnellon,Adrian Gardner,Matthew Harris,Caroline Leech,Steve Mathieu,P Moor,Lara Prisco,Kate Rivett,Frances Tait,Kariem El‐Boghdadly
出处
期刊:Anaesthesia [Wiley]
卷期号:79 (8): 856-868 被引量:27
标识
DOI:10.1111/anae.16290
摘要

Summary Background There are concerns that airway management in patients with suspected or confirmed cervical spine injury may exacerbate an existing neurological deficit, cause a new spinal cord injury or be hazardous due to precautions to avoid neurological injury. However, there are no evidence‐based guidelines for practicing clinicians to support safe and effective airway management in this setting. Methods An expert multidisciplinary, multi‐society working party conducted a systematic review of contemporary literature (January 2012–June 2022), followed by a three‐round Delphi process to produce guidelines to improve airway management for patients with suspected or confirmed cervical spine injury. Results We included 67 articles in the systematic review, and successfully agreed 23 recommendations. Evidence supporting recommendations was generally modest, and only one moderate and two strong recommendations were made. Overall, recommendations highlight key principles and techniques for pre‐oxygenation and facemask ventilation; supraglottic airway device use; tracheal intubation; adjuncts during tracheal intubation; cricoid force and external laryngeal manipulation; emergency front‐of‐neck airway access; awake tracheal intubation; and cervical spine immobilisation. We also signpost to recommendations on pre‐hospital care, military settings and principles in human factors. Conclusions It is hoped that the pragmatic approach to airway management made within these guidelines will improve the safety and efficacy of airway management in adult patients with suspected or confirmed cervical spine injury.
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