HSC Section 3 - Trauma, Critical Care and Sleep Medicine

II. CRITICAL CARE AND PERIOPERATIVE CARE A. Complex airway management 1. Managing the “difficult” airway

Detsky ME, Jivraj N, Adhikari NK, et al. Will this patient be difficult to intubate? The Rational Clinical Examination systematic review. JAMA . 2019; 321(5):493-503. EBM level 1.............83-93

Summary : This meta-analysis evaluates risk factors and physical findings as a means of predicting a difficult intubation. While no clinical finding reliably excludes a difficult intubation, an abnormal upper lip bite test raises the probability from 10% to greater than 60%.

Pandian V, Zhen G, Stanley S, et al. Management of difficulty airway among patients with oropharyngeal angioedema. Laryngoscope . 2019; 129(6):1360-1367. EBM level 3..............94-101

Summary : This article reviews the experience of the Difficult Airway Response Team (DART) at a single institution in responding to angioedema cases. The article reviews outcomes of patients in the pre-DART group versus the post-DART cohort. 2. Tracheostomy protocols Masood MM, Farquhar DR, Biancaniello C, Hackman TG. Association of standardized tracheostomy care protocol implementation and reinforcement with the prevention of life- threatening respiratory events. JAMA Otolaryngol Head Neck Surg . 2018; 144(6):527-532. EBM level 3........................................................................................................................................102-107 Summary : This study compares a cohort of patients that received a standardized tracheostomy perioperative care protocol. It compares outcomes, including life-threatening events, in patients before and after the protocol was implemented at the institution. It demonstrated a reduction in life- threatening rapid-response calls for mucus plugging. Summary : This article investigated the effect of an institutional quality-improvement protocol to reduce the incidence of tracheostomy pressure ulcers. The incidence decreased from 10.9% to 1.3%. B. Management of head and neck hemorrhage Cogbill TH, Cothren CC, Ahearn MK, et al. Management of maxillofacial injuries with severe oronasal hemorrhage: a multicenter perspective. J Trauma . 2008; 65(5):994-999. EBM level 4..............118-123 Summary : This is a retrospective review in which seven trauma registries from nine trauma centers were queried over a 7-year period for injuries with an abbreviated injury scale face ≥ 3 and transfusion of ≥ 3 units of blood within 24 hours. An algorithm was devised for management of patients with severe oronasal hemorrhage after maxillofacial trauma. O'Toole TR, Jacobs N, Hondorp B, et al. Prevention of tracheostomy-related hospital-acquired pressure ulcers. Otolaryngol Head Neck Surg . 2017; 156(4):642-651. EBM level 3............108-117