Airway Trauma

 

 

Considerations

 

  • Emergency, full stomach

  • Trauma with ATLS approach 

  • Difficult intubation & bag mask ventilation with possibility of complete obstruction

    • Plan for surgical airway backup

  • Co-existing injuries: unstable C-spine, traumatic brain injury, tracheobronchial disruption, vascular injury

  • Trauma considerations

 

 

Goals

 

  • Safe establishment of airway (spontaneous ventilation, get tube beyond injury)

  • Minimize C-spine movement

 

 

Conflicts

 

  • Full stomach vs difficult airway vs need for double lumen tube

  • Uncooperative or pediatric patient vs difficult airway

 

 

Airway Plan

 

  • Determine location of trauma: supraglottic, laryngotracheal, infracarinal

  • Bypass area of trauma during airway management

  • Supraglottic

    • Most preferred technique is tracheostomy

    • Awake vs. double setup after attempting direct laryngoscopy/video laryngoscopy/fiberoptic bronchoscopy

  • Laryngotracheal

    • Use awake, spontaneous ventilation technique under direct vision (fiberoptic bronchoscopy)

  • Infracarinal

    • Injury causing bronchopleural fistula with air leak, risk of tension pneumothorax &/or difficult ventilation during positive pressure ventilation

    • Secure airway with lung isolation: double lumen tube, bronchial blocker, single lumen tube placed endobronchially

    • Maintain spontaneous ventilation or rapid sequence induction while avoiding positive pressure ventilation until lung isolation

Further Reading 

  • Uday Jain, Maureen McCunn, Charles E. Smith, Jean-Francois Pittet; Management of the Traumatized Airway. Anesthesiology 2016; 124:199–206

  • S. J. Mercer, C. P. Jones, M. Bridge, E. Clitheroe, B. Morton, P. Groom, Systematic review of the anaesthetic management of non-iatrogenic acute adult airway trauma, BJA: British Journal of Anaesthesia, Volume 117, Issue suppl_1, September 2016, Pages i49–i59