Академический Документы
Профессиональный Документы
Культура Документы
• NAP4 (2011)
Porque ??
-Republication: All India Difficult Airway Association 2016 Guidelines for Tracheal Intubation in the Intensive Care Unit. Indian J Crit Care Med. 2017 Mar; 21(3): 146–153
-Cook TM, Woodall N, Harper J, Benger J. Fourth National Audit Project. Major complications of airway management in the UK: Results of the Fourth National Audit Project of the Royal College of Anaesthetists
and the Difficult Airway Society. Part 2: Intensive care and emergency departments. Br J Anaesth. 2011;106:632–42. [PubMed: 21447489]
Desafíos durante la IT en UCI
-Republication: All India Difficult Airway Association 2016 Guidelines for Tracheal Intubation in the Intensive Care Unit. Indian J Crit Care Med. 2017 Mar; 21(3): 146–153
CONSUMO DE OXIGENO TRANSPORTE DE
(VO2 ML /MIN) OXIGENO
(DO2 ML/MIN)
SINTESIS PROTEICA
HIPERTERMIA
CONTENIDO ARTERIAL DE O2
INFLAMACION
HEMOGLOBINA, Pao2, SatO2
TRABAJO RESPIRATORIO
AGITACION
DOLOR …
PRESION DE
PERFUSION
Incidencia de complicaciones durante la IT de
urgencia en UCI varia entre 22% a 54%
-Republication: All India Difficult Airway Association 2016 Guidelines for Tracheal Intubation in the Intensive Care Unit. Indian J Crit Care Med. 2017 Mar; 21(3): 146–153
Incidencia de complicaciones
COMPLICACIONES PRIMER INTENTO 2 ó + INTENTOS
BRONCOASPIRACION 2% 22%
HIPOXEMIA 12% 70%
PCR 1% 11%
-Mort TC. Emergency tracheal intubation: Complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99:607–13. [PubMed: 15271750]
Incidencia de complicaciones
La hipotensión evento adverso más común (hasta 45%)
Pero ..
http://bja.oxfordjournals.org/content/106/5/632.full.pdf+html
PREDICTORES IT DIFICIL EN UCI
Score MACOCHA
FACTORES
- ANATOMICOS
- FISIOLOGICOS
- EXPERIENCIA
- Máximo de 12 puntos
- 0 puntos predice una intubación fácil
- 12 puntos predice una muy difícil.
- Sensibilidad del 73%
- No ha sido validado para la video laringoscopia
De Jong A, Molinari N, Terzi N, Mongardon N, Arnal JM, Guitton C, et al. Early identification of patients at risk for difficult intubation in the Intensive Care Unit: Development and validation of the
MACOCHA score in a multicenter cohort study. Am J Respir Crit Care Med. 2013;187:832–9. [PubMed: 23348979]
ID se definió como:
3 o más intentos laringoscópicos para colocar TET o
más de 10 minutos usando la laringoscopia convencional.
De Jong A, Molinari N, Terzi N, Mongardon N, Arnal JM, Guitton C, et al. Early identification of patients at risk for difficult intubation in the Intensive Care Unit: Development and validation of the
MACOCHA score in a multicenter cohort study. Am J Respir Crit Care Med. 2013;187:832–9. [PubMed: 23348979]
Consideraciones especiales IT
EVIDENCIA
• Tres minutos de preoxigenación utilizando VNI con PP suministrada por un ventilador usando una
máscara facial
• Cánula nasal de alto flujo, con 30-50 L / min , dispositivo capaz de proporcionar oxígeno
humidificado
-Republication: All India Difficult Airway Association 2016 Guidelines for Tracheal Intubation in the Intensive Care Unit. Indian J Crit Care Med. 2017 Mar; 21(3): 146–153
Jaber S, Monnin M, Girard M et al. (2016) Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic
patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med, Oct 11
Lavado del espacio muerto faríngeo.
Reducción de la resistencia nasofaríngea.
Presión positiva al final de la espiración (efecto CPAP).
Humidificación, mayor confort y mejor tolerancia.
Mejor control de la FiO2 y mejor aclaramiento mucociliar.
Samir Jaber, Marion Monnin, Mehdi Girard, Matthieu Conseil, Moussa Cisse, Julie Carr, Martin Mahul, Jean Marc Delay, Fouad Belafia, Gérald Chanques,
Nicolas Molinari and Audrey De Jong. 2016 Springer-Verlag Berlin Heidelberg and ESICM
-De Jong A, Jung B, Jaber S (2014a) Intubation in the ICU: we could improve our practice. Crit Care, 18(2): 209
-Jaber S, Monnin M, Girard M et al. (2016) Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the
intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial. Intensive Care Med, Oct 11
TALLER DE VIA AEREA:
INTUBACION ENDOTRAQUEAL EN UCI