McCluskey, K. & Stephens, M. Anaesthesia and intensive care medicine | Published online: 4 March 2017
Conventional direct laryngoscopy with the curved Macintosh blade is a fundamental skill for all anaesthetists and has been the cornerstone of airway management for many years. This technique relies on the operator aligning the oro-pharyngo-laryngeal structures and inserting an endotracheal tube into the trachea under direct vision. There is a recognized failure rate with this technique and thus alternative techniques for tracheal intubation should be available for use in difficult situations.
Awake fibreoptic intubation (AFOI) remains the ‘gold standard’ method for securing the airway in an anticipated difficult intubation. Advances in optical technology over recent years have lead to the development of several rigid indirect devices, which improve glottic visualization by enabling the operator to ‘see around the corner’. With improved views at laryngoscopy these videolaryngoscopes are emerging as important tools in airway management and useful teaching and training aids.
Wik, L.Current Opinion in Critical Care. June 2016. Volume 22 (3). pp. 191–198
Purpose of review: This article explores the status of using near-infrared spectroscopy and reporting cerebral oximetry (rSO2) for cardiac arrest patients.
Recent findings: Bystander cardiopulmonary resuscitation (CPR) patients have significantly higher rSO2 compared with no bystander CPR patients. It is unclear how quickly rSO2changes with hemodynamic instability. rSO2 during mechanical CPR varies between 44 and 55% and manual CPR varies between 20 and 40%, representing a significant relative rSO2increase. Studies have found a relationship between rSO2 and restoration of spontaneous circulation (ROSC) and rSO2 increase can be used as a sign of ROSC. rSO2 evaluation is effective for monitoring quality of resuscitation and neurological prognostication. It seems that cardiac arrest patients with good neurologic outcome have significantly higher rSO2 levels (CPC 1–2 median rSO2 68%, CPC 3–5 median rSO2 58%, P < 0.01) and good neurologic outcome (CPC 1–2) increased ‘in proportion to the patients’ rSO2 levels irrespective of their ROSC status at hospital arrival’. However, most of the studies are small and a prospective outcome study focusing on rSO2 values is needed.
Summary: Near-infrared spectroscopy and rSO2 have been used as a monitor during CPR, detection of ROSC, after ROSC, and during post-resuscitation care. Prospective, controlled, randomized clinical studies are needed to document their wide use.
A potentially revolutionary new technology – that could saves thousands of lives in Intensive Care Units around the world – is being trialled in a UK study co-led by Queen’s University Belfast.
Covering 1,120 critically ill patients in 40 different sites in Britain and Northern Ireland over five years, the research project will test a new strategy designed to minimise damage to the lungs caused by mechanical ventilation – commonly referred to as ‘ventilators’. The study will be one of the largest clinical trials in the world, to date, involving patients with respiratory failure.
The National Institute for Health Research (NIHR) has funded the £2.1 million research which will be jointly led by Queen’s and Belfast Health and Social Services Trust.
For more details see the report on Queen’s University website link
Hypovolemia, anemia and hypoxemia may cause critical deterioration in the oxygen delivery (DO2 ). Their early detection followed by a prompt and appropriate intervention is a cornerstone in the care of critically ill patients. And yet, the remedies for these life-threatening conditions, namely fluids, blood and oxygen, have to be carefully titrated as they are all associated with severe side-effects when administered in excess.
New technological developments enable us to monitor the components of DO 2 in a continuous non-invasive manner via the sensor of the traditional pulse oximeter. The ability to better assess oxygenation, hemoglobin levels and fluid responsiveness continuously and simultaneously may be of great help in managing the DO 2 .
The non-invasive nature of this technology may also extend the benefits of advanced monitoring to wider patient populations.