Critical care clinics
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Tracheal insufflation of oxygen has at least three major uses for chronic oxygen supplementation through a percutaneous catheter, it is an adjunctive measure to enhance gas exchange during mechanical ventilation, and it provides an emergency therapy for oxygen delivery with upper airway obstruction. In this article the mechanisms of gas exchange and techniques of oxygen delivery are described for each of these major uses.
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Critical care clinics · Jul 2000
ReviewEmergent airway management. Indications and methods in the face of confounding conditions.
Optimal airway management requires an experienced caregiver, attention to detail, and knowledge of the patient's physiology. A variety of pharmacologic agents have proved useful in obtaining a secure airway and minimizing risk to the patient. Depending on the skills of the caregiver, oral intubation has become the preferred means of airway control in most patients. Advances in technique, equipment, and pharmacology have greatly improved the art of airway management; however, there is no substitute for an experienced clinician.
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In summary, the need to manipulate the airway in the pregnant patient requires careful consideration and substantial planning. Anatomic and physiologic changes of pregnancy, coexisting conditions, and the potential for aspiration all carry a risk of morbidity and, indeed, mortality. Preparation, including early and repeated airway evaluations throughout pregnancy and labor, is encouraged. ⋯ Equipment must be available and in good condition. Finally, proper education and review for individuals involved in the delivery of care on the labor floor are mandatory. Although it is not always possible to control the manner in which these patients present, it is usually possible to control the environment into which they present.
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Airway management in the pediatric patient requires an understanding and knowledge of the differences and characteristics unique to the child and infant. New and exciting techniques are currently being explored and developed for management of the pediatric airway. ⋯ Work continues to probe for methods and ways that will allow us to take care of infants and children better and to provide the safest and most effective means of delivering that care. No doubt, there will be more advances and exciting ideas to come that lead to better management of the pediatric airway.
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Patients who are difficult to intubate are randomly encountered. Patients who are in the postoperative period or who have suffered trauma have a greater chance of being difficult to intubate. The ability to quickly mobilize trained personnel and advanced equipment provides the best chance for a good outcome for these patients. Practice in placement of and intubation with LMAs is an important step toward providing an extensive safety net for patients needing intubation.