How to predict a difficult airway

Abstract

Težavna oskrba dihalne poti je po definiciji ameriškega anesteziološkega združenja klinična situacija, pri kateri ima izkušen anesteziolog težave s predihavanjem bolnika z masko in dihalnim balonom in/ali težave s prikazom grla z direktno laringoskopijo in vstavitvijo dihalne cevke. Strah pred neuspešno oskrbo dihalne poti spremlja vsakega zdravnika. Klinični pregled z oceno možnosti težavne oskrbe dihalne poti je obvezen pred vsako oskrbo dihalne poti tako pri otrocih kot pri odraslih. Z njim se izognemo nepričakovani težki oskrbi dihalne poti in posledičnim zapletom. Tveganje za težavno oskrbo dihalne poti ocenimo z anamnezo in pregledom medicinske dokumentacije ter usmerjenim kliničnim pregledom bolnika. Vsak test ali klinični znak, ki natančno oceni tveganje za težavno oskrbo dihalne poti, ima svojo senzitivnost in specifičnost za oceno tveganja težke oskrbe dihalne poti. Za vse teste ali klinične znake so značilne nizka associsenzitivnost, zmerna specifičnost in nizka pozitivna napovedna vrednost. Na podlagi multivariantne analize je bilo razvitih veliko točkovnih modelov, v katere so bili vključeni različni testi in klinični znaki z namenom izboljšanja napovedi težavne oskrbe dihalne poti, vendar z zelo različno točnostjo napovedi težke oskrbe dihalne poti. Evropsko združenje za anesteziologijo priporoča sistematsko uporabo ocenjevalnega modela pred vsako oskrbo dihalne poti, ki vključuje: Mallampatijev test, thiromentalno razdaljo, oceno odpiranja ust z medzobno razdaljo, oceno gibljivosti vratu, oceno podajnosti mandibularnega prostora in oceno gibljivosti spodnje čeljusti.

Keywords

napoved;težka oskrba dihalne poti;predihavanje z masko;vstavitev dihalne cevke;ocena dihalne poti;

Data

Language:	English
Year of publishing:	2013
Typology:	1.02 - Review Article
Organization:	UM - University of Maribor
Publisher:	Medicinska fakulteta
UDC:	616-089.819.3
COBISS:	4682303
ISSN:	1855-5640
Parent publication:	Acta medico-biotechnica
Views:	3
Downloads:	0
Average score:	0 (0 votes)
Metadata:

Other data

Secondary language:	Slovenian
Secondary title:	Kako napovedati težavno oskrbo dihalne poti
Secondary abstract:	According to The American Society of Anaesthesiologists Task Force, a difficult airway is defined as a clinical situation in which a conventionallytrained anaesthesiologist experiences difficulty with face mask ventilation and/or difficulty with tracheal intubation. Failing at efficient airway management is a source of major apprehension for physicians. Predicting difficult airway management is a mandatory part of clinical practice for paediatric and adult patients so as to avoid unexpected difficult airway management and adverse outcomes. Predicting a difficult airway is based on a focused medical history, review of prior medical records, physical examination, and specific tests for airway assessment. Each feature or airway test has its own sensitivity and specificity for the prediction of a difficult airway. All airway assessment tests are characterised by low sensitivity, reasonable specificity, and a low positive predictive value. Several scoring system models have been developed by multivariate analysis with multiple different integrated tests or risk factors to improve the prediction of a difficult airway, but with considerably different effectiveness to predict a difficult airway. According to the European Society of Anaesthesiology, systematic multimodal screening before airway management should include the Mallampati classification and thyromental distance, mouth opening or interincisor distance, range of motion of head and neck, compliance of the mandibular space, and the upper lip bite test.
Secondary keywords:	dihalna pot, oskrba;dihalna pot, ocena;dihalna cevka;dihalni balon;maska;predihavanje;
Type (COBISS):	Scientific work
Pages:	str. 10-19
Volume:	ǂVol. ǂ6
Issue:	ǂ[no.] ǂ1
Chronology:	2013
ID:	23412316