Systematic review of the anaesthetic management of non-iatrogenic acute adult airway trauma

Mercer, S J, Jones, C P, Bridge, M, Clitheroe, E, Morton, Ben ORCID: https://orcid.org/0000-0002-6164-2854 and Groom, P (2016) 'Systematic review of the anaesthetic management of non-iatrogenic acute adult airway trauma'. British journal of anaesthesia, Vol 117, Issue Suppl. 1, i49-i59.

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Abstract

Introduction
Non-iatrogenic trauma to the airway is rare and presents a significant challenge to the anaesthetist. Although guidelines for the management of the unanticipated difficult airway have been published, these do not make provision for the ‘anticipated’ difficult airway. This systematic review aims to inform best practice and suggest management options for different injury patterns.

Methods
A literature search was conducted using Embase, Medline, and Google Scholar for papers after the year 2000 reporting on the acute airway management of adult patients who suffered airway trauma. Our protocol and search strategy are registered with and published by PROSPERO (http://www.crd.york.ac.uk/PROSPERO, ID: CRD42016032763).

Results
A systematic literature search yielded 578 articles, of which a total of 148 full-text papers were reviewed. We present our results categorized by mechanism of injury: blunt, penetrating, blast, and burns.

Conclusions
The hallmark of airway management with trauma to the airway is the maintenance of spontaneous ventilation, intubation under direct vision to avoid the creation of a false passage, and the avoidance of both intermittent positive pressure ventilation and cricoid pressure (the latter for laryngotracheal trauma only) during a rapid sequence induction. Management depends on available resources and time to perform airway assessment, investigations, and intervention (patients will be classified into one of three categories: no time, some time, or adequate time). Human factors, particularly the development of a shared mental model amongst the trauma team, are vital to mitigate risk and improve patient safety.

Item Type:	Article
Uncontrolled Keywords:	airway management; blast injuries; blunt injuries; burns; wounds, penetrating
Subjects:	W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care WF Respiratory System > WF 140 Diseases of the respiratory system (General) WO Surgery > Anesthesia > WO 200 Surgical anesthesia. Analgesia (General) WO Surgery > Traumatic Injuries > WO 700 General works
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1093/bja/aew193
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	10 Oct 2016 09:28
Last Modified:	06 Feb 2018 13:13
URI:	https://archive.lstmed.ac.uk/id/eprint/6126

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