Systematic review of the anaesthetic management of non-iatrogenic acute adult airway trauma
Open accessAbstract
Introduction Non-iatrogenic trauma to the airway is rare and presents a significant challenge to the anaesthetist. Although guidelines for the management of the unanticipated difficult airway have been published, these do not make provision for the 'anticipated' difficult airway. This systematic review aims to inform best practice and suggest management options for different injury patterns. Methods A literature search was conducted using Embase, Medline, and Google Scholar for papers after the year 2000 reporting on the acute airway management of adult patients who suffered airway trauma. Our protocol and search strategy are registered with and published by PROSPERO (http://www.crd.york.ac.uk/PROSPERO, ID: CRD42016032763). Results A systematic literature search yielded 578 articles, of which a total of 148 full-text papers were reviewed. We present our results categorized by mechanism of injury: blunt, penetrating, blast, and burns. Conclusions The hallmark of airway management with trauma to the airway is the maintenance of spontaneous ventilation, intubation under direct vision to avoid the creation of a false passage, and the avoidance of both intermittent positive pressure ventilation and cricoid pressure (the latter for laryngotracheal trauma only) during a rapid sequence induction. Management depends on available resources and time to perform airway assessment, investigations, and intervention (patients will be classified into one of three categories: no time, some tim…
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For patients with known or suspected airway injury, the safest way to facilitate ETI is placement of the ETT under direct visualization, ideally from the oropharynx to the carina using an FIE.
“For patients with known or suspected airway injury, the safest way to facilitate ETI is placement of the ETT under direct visualization, ideally from the oropharynx to the carina using an FIE.68,70”
From Airway Management in Trauma (2018) · cites this paper as [68]
Practitioners have infrequent or limited experience in managing patients with primary airway trauma and existing management guidelines for care of these patients are mostly based on expert opinion.
“practitioners have infrequent or limited experience in managing these patients and existing management guidelines for care of these patients are mostly based on expert opinion.68”
From Airway Management in Trauma (2018) · cites this paper as [68]
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Kovacs, G., & Sowers, N. (2018) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2017.08.006 · Cited by 115 · see citing works
- Authors
- Mercer, S. J., Jones, C. P., Bridge, M., Clitheroe, E., Morton, B., & Groom, P.
- Affiliations
- University of Liverpool (GB)
- Aintree University Hospitals NHS Foundation Trust (GB)
- Liverpool School of Tropical Medicine (GB)
- Venue
- British Journal of Anaesthesia
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 117
- Pages
- i49-i59
- ISSN
- 0007-0912 (ISSN-L)
- OpenAlex
- W2511390194
- Cited by
- 53
- References
- 0
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 5 · 2023: 6 · 2022: 8 · 2021: 9 · 2020: 4 · 2019: 3 · 2018: 2 · 2017: 4 · 2016: 1
- FWCI
- 0.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- British Journal of Anaesthesia (publishedVersion)
- PubMed (publishedVersion)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Edge Hill University Research Information Repository (Edge Hill University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Tracheal and airway disorders
- Health Sciences › Medicine › Surgery › Trauma Management and Diagnosis
- Keywords
- airway injury, anesthetic management, anticipated difficult airway, unanticipated difficult airway, blast injury, airway burns, laryngotracheal injury, rapid sequence induction, intermittent positive pressure ventilation, cricoid pressure, shared mental models, patient safety
- MeSH terms
- Anesthesia, General, Burns, Humans, Intubation, Intratracheal, Larynx, Respiratory System, Trachea, Wounds, Nonpenetrating, Wounds, Penetrating, Airway Management
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