Resp Care
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Ventilator-associated pneumonia (VAP) is a pervasive and expensive nosocomial infection that is largely related to instrumentation of the airway with an endotracheal tube (ETT), followed by microaspiration of contaminated secretions. VAP prevention will probably be most effective via a multifaceted approach, which includes meticulous attention to basic infection-control methods during patient care, proper patient positioning, oral hygiene, and removal of the ETT as soon as indicated. ⋯ Most importantly, cost-effectiveness data are lacking for modified ETTs designed to prevent VAP. It is critical that future studies of ETTs designed to prevent VAP be adequately powered to demonstrate efficacy on important patient outcomes and safety, in addition to cost-effectiveness.
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The development of less expensive, smaller, and more reliable video cameras has revolutionized the design of laryngoscopes and the process of endotracheal intubation. The term video laryngoscopy defines a broad range of devices, distinct from fiberoptic bronchoscopes, in which a video camera is used in place of line-of-sight visualization to accomplish endotracheal intubation. ⋯ Each model of video laryngoscope has its own unique strengths, weaknesses, and best applications. For the purposes of this review, video laryngoscopes are grouped into 3 different designs: stylets, guide channels, and video modifications of the traditional (usually Macintosh) laryngoscope blades.
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Emergency airway management is associated with a high complication rate. Evaluating the patient prior to airway management is important to identify patients with increased risk of failed airways. Pre-oxygenation of critically ill patients is less effective in comparison to less sick patients. ⋯ Supervision of emergency airway management by attending physicians significantly decreases complications. Standardized algorithms may increase the success of emergency intubation. Attention should be paid to cardiopulmonary stability in the immediate post-intubation period.