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Managing and securing the bleeding upper airway: a narrative review

Research output: Contribution to journalReviewResearchpeer-review

  1. Point-of-care ultrasound (POCUS) of the upper airway

    Research output: Contribution to journalReviewResearchpeer-review

  2. Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. A systematic review of vasopressor blood pressure targets in critically ill adults with hypotension

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. CCCS-SSAI WikiRecs Clinical Practice Guideline: vasopressors in early traumatic shock

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. CCCS-SSAI WikiRecs Clinical Practice Guideline: vasopressor blood pressure targets in critically ill adults with hypotension

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. From variance to guidance for awake tracheal intubation

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Depth to the airway lumen at the level of the cricothyroid membrane measured by ultrasound

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. A simple clinical assessment is superior to systematic triage in prediction of mortality in the emergency department

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Preoperative ultrasound measurement of depth to the airway at the level of the cricothyroid membrane correlates with patient weight

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Ultrasonography for Airway Management

    Research output: Chapter in Book/Report/Conference proceedingBook chapterCommunication

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Failure to manage bleeding in the airway is an important cause of airway-related death. The purpose of this narrative review is to identify techniques and strategies that can be employed when severe bleeding in the upper airway may render traditional airway management (e.g., facemask ventilation, intubation via direct/video laryngoscopy, flexible bronchoscopy) impossible because of impeded vision. An extensive literature search was conducted of bibliographic databases, guidelines, and textbooks using search terms related to airway management and bleeding. We identified techniques that establish a definitive airway, even in cases of impeded visibility resulting from severe bleeding in the airway. These include flexible video-/optical- scope-guided intubation via a supraglottic airway device; cricothyroidotomy or tracheotomy; and retrograde-, blind nasal-, oral-digital-, light-, and ultrasound-guided intubation. We provide a structured approach to managing bleeding in the airway that accounts for the source of bleeding and the estimated risk of failure to intubate using direct laryngoscopy or to achieve a front-of-neck access for surgical airway rescue. In situations where these techniques are predicted to be successful, the recommended approach is to identify the cricothyroid membrane (in preparation for rescue cricothyroidotomy), followed by rapid sequence induction. In situations where traditional management of the airway is likely to fail, we recommend an awake approach with one of the aforementioned techniques.

Original languageEnglish
JournalCanadian journal of anaesthesia = Journal canadien d'anesthesie
Volume67
Issue number1
Pages (from-to)128-140
ISSN0832-610X
DOIs
Publication statusPublished - Jan 2020

ID: 58123492