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Advisor(s)
Abstract(s)
A abordagem da via aérea é a primeira etapa em situações de emergência, e a intubação
traqueal é o gold standard, recorrendo-se geralmente à laringoscopia direta. Existem
outros dispositivos médicos que permitem realizar intubação traqueal, com visualização
indireta da glote, nomeadamente os videolaringoscópios (tecnologia de vídeo) e os
laringoscópios óticos (tecnologia de fibra ótica).
Pretendemos analisar se os dispositivos de laringoscopia indireta aumentam a taxa de
sucesso de intubação traqueal em situações de emergência, quando comparados à
laringoscopia direta. A hipótese que colocamos, deve-se ao facto destes dispositivos
oferecerem melhor visualização da glote e, nas situações de emergência, as condições de
intubação serem especialmente difíceis e exigentes.
As situações de emergência, em que é necessário abordar a via aérea, podem ocorrer no
contexto pré-hospitalar e intra-hospitalar. A experiência do profissional influencia a
qualidade da técnica de intubação praticada com os dispositivos de laringoscopia (diretos
ou indiretos).
Existem diferentes dispositivos em cada classe de laringoscópios referidos, e cada um
tem as suas características e modos de utilização, que devem ser treinados pelos
profissionais. Nos profissionais menos experientes, a prática com dispositivos de
laringoscopia indireta pode ajudar a familiarizarem-se com a via aérea, facilitando desse
modo a técnica de laringoscopia direta.
Também no contexto da pandemia COVID-19, nos últimos 2 meses têm-se multiplicado
as recomendações, de várias sociedades nacionais e internacionais, para utilização de
videolaringoscopia para a abordagem da via aérea do doente com COVID-19, realçando
outra vantagem da técnica, permitir uma maior distância entre o profissional e a via
aérea do doente.
Concluímos que a laringoscopia indireta é uma ferramenta útil na abordagem da via
aérea em situações de emergência, oferecendo taxas de sucesso na intubação traqueal
mais altas que a laringoscopia direta. No entanto, estes resultados favoráveis apenas se
verificam em profissionais inexperientes. Nestes profissionais, a laringoscopia indireta,
de forma geral, reduziu os tempos de intubação, e o número de tentativas de intubação.
Nos profissionais de saúde com experiência de abordagem da via aérea, a utilização de laringoscopia indireta não se revelou tão vantajosa. Em alguns estudos, as prestações dos
profissionais foram piores comparativamente à laringoscopia direta.
Uma outra vantagem da laringoscopia indireta na intubação traqueal, que é transversal
a todos os profissionais, é o menor número de intubações esofágicas. As taxas de
mortalidade e morbilidade entra a laringoscopia direta e indireta são semelhantes.
Airway management is the first step in emergency situations, and tracheal intubation is the gold standard, usually using direct laryngoscopy. There are other medical devices to perform tracheal intubation, with indirect visualization of the glottis, namely videolaryngoscopes (video technology) and optical laryngoscopes (fiber optic technology). Our main goal is to analyze if indirect laryngoscopy devices increase the success rate of tracheal intubation in emergency situations, when compared to direct laryngoscopy. This hypothesis is due to the fact that these devices offer better visualizations of the glottis, and in emergency situations, intubation conditions are especially difficult and demanding. Emergency situations, in which it´s necessary to manage the airway, can occur in the pre-hospital and in-hospital setting. The professional's experience influences the quality of intubation technique practiced with laryngoscopy devices (direct or indirect). There are different devices in each class of laryngoscopes referred. Each of the equipment, has its own characteristics, and modes of use, that must be trained by professionals. In unexperienced professionals, the practice with indirect laryngoscopy devices can help professionals becoming familiar with airway, thereby facilitating the technique of direct laryngoscopy. Also in the context of COVID-19 pandemic, in the last 2 months, several national and international societies, encourage the use of videolaryngoscopy to perform tracheal intubation of those patients, highlighting another advantage of the technique, a greater distance from the professional to the patient's airway. We conclude that indirect laryngoscopy is a useful tool in airway management in emergency situations, offering success rates in tracheal intubation higher than direct laryngoscopy. However, these favorable results are only found in inexperienced professionals. In these professionals, indirect laryngoscopy, in general, reduced intubation time and the number of intubation attempts. In health professionals experienced in airway management, the use of indirect laryngoscopy was not so advantageous. In some studies, the performance of professionals was worse compared to direct laryngoscopy. Another advantage of indirect laryngoscopy in tracheal intubation, which is transverse to all professionals, is the smallest number of esophageal intubations. The mortality and morbidity rates between direct and indirect laryngoscopy are similar.
Airway management is the first step in emergency situations, and tracheal intubation is the gold standard, usually using direct laryngoscopy. There are other medical devices to perform tracheal intubation, with indirect visualization of the glottis, namely videolaryngoscopes (video technology) and optical laryngoscopes (fiber optic technology). Our main goal is to analyze if indirect laryngoscopy devices increase the success rate of tracheal intubation in emergency situations, when compared to direct laryngoscopy. This hypothesis is due to the fact that these devices offer better visualizations of the glottis, and in emergency situations, intubation conditions are especially difficult and demanding. Emergency situations, in which it´s necessary to manage the airway, can occur in the pre-hospital and in-hospital setting. The professional's experience influences the quality of intubation technique practiced with laryngoscopy devices (direct or indirect). There are different devices in each class of laryngoscopes referred. Each of the equipment, has its own characteristics, and modes of use, that must be trained by professionals. In unexperienced professionals, the practice with indirect laryngoscopy devices can help professionals becoming familiar with airway, thereby facilitating the technique of direct laryngoscopy. Also in the context of COVID-19 pandemic, in the last 2 months, several national and international societies, encourage the use of videolaryngoscopy to perform tracheal intubation of those patients, highlighting another advantage of the technique, a greater distance from the professional to the patient's airway. We conclude that indirect laryngoscopy is a useful tool in airway management in emergency situations, offering success rates in tracheal intubation higher than direct laryngoscopy. However, these favorable results are only found in inexperienced professionals. In these professionals, indirect laryngoscopy, in general, reduced intubation time and the number of intubation attempts. In health professionals experienced in airway management, the use of indirect laryngoscopy was not so advantageous. In some studies, the performance of professionals was worse compared to direct laryngoscopy. Another advantage of indirect laryngoscopy in tracheal intubation, which is transverse to all professionals, is the smallest number of esophageal intubations. The mortality and morbidity rates between direct and indirect laryngoscopy are similar.
Description
Keywords
Abordagem de Via Aérea Intubação Traqueal Laringoscopia Ótica Medicina de Emergência Videolaringoscopia