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LETTER TO THE EDITOR

Do Patients Need Oxygen in Their Lungs or a Cuff in Their Trachea?

Oregon Anesthesiology Group; Portland, Oregon; SamuelMetz{at}SamuelMetz.com

To the Editor:

von Goedecke et al. (1) in their editorial and Timmermann et al. (2) in their article comment on the dangers of unrecognized esophageal intubation by out-of-hospital care providers using direct laryngoscopy. Their solutions to this problem include: 1) proper direct laryngoscopy equipment, 2) capnography, 3) availability of alternative intubating techniques, and 4) maintenance of skills and vigilance with on-going training.

The editorial and article allude to but stop short of making what may be an important point. In the field, patients are in greater danger of hypoxic death than aspiration pneumonitis. Perhaps, one solution is to replace direct laryngoscopy with other devices to maintain oxygenation in the field.

Potential disadvantages of supraglottic airways are lesser protection against aspiration and the chance of laryngospasm. The clinical significance of these theoretical disadvantages is uncertain.

Perhaps, our best method of reducing unrecognized esophageal intubation in the field is to designate a supraglottic airway as the primary technique when bag-mask ventilation fails or is inappropriate. Direct laryngoscopy may then be reserved for use only when supraglottic airway fails to provide oxygenation. This point has been made before (3).

Trauma centers may possibly see more patients arrive from the field with aspiration pneumonitis but fewer with hypoxic brain injury.

Footnotes

Dr. Timmerman does not wish to respond.

REFERENCES

1. von Goedecke A, Herff H, Paal P, Dorges V, Wenzel V. Field airway management disasters. Anesth Analg 2007;104:481–3[Free Full Text]
2. Timmermann A, Russo SG, Eich C, Roessler M, Braun U, Rosenblatt WH, Quintel M. The out-of-hospital esophageal and endobronchial intubations performed by emergency medical service physicians. Anesth Analg 2007;104:619–23[Abstract/Free Full Text]
3. Scott DB. Endotracheal intubation: friend or foe. BMJ (Clin Res Ed) 1986;292:157–8[Free Full Text]

This article has been cited by other articles:

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Metz, S. Search for Related Content PubMed PubMed Citation Articles by Metz, S.