The 1991 Fraser Gurd Lecture: evolution of airway control in the management of injured patients.
The evolution of methods for airway control has been an important factor in improving overall trauma care. Many important advances have been made in technique, tubes, and timing. Current methods of airway control are listed in Table 2 and are categorized as emergency or elective. It is always assumed that basic life support techniques will be in place before this hierarchic scheme for airway control is used. Unfortunately, hypoxemia continues to be a factor in preventable trauma deaths. There is much to be done in the future to further improve airway management in injured patients. There is an immediate need to assess methods of airway control in the pre-hospital phase using a randomized clinical trial. The ideal tube for cricothyroidotomy, tracheostomy, or endotracheal intubation remains to be designed. There is a need for further multicenter trials on the timing of tracheostomy in the critical care unit. The role of differential ventilators in the management of unilateral pulmonary parenchymal injury requires clinical validation. Intravascular membrane oxygenators have been proposed in advanced pulmonary insufficiency in a ventilated patient. Thus, while many important strides have been made in airway management following trauma, there remain great challenges in addressing the persistent problem of systemic hypoxemia after multiple injuries.
Mulder
D S
DS
Department of Surgery, McGill University/Montreal General Hospital, Quebec, Canada.
Marelli
D
D
D004630:Emergencies; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy*; D007442:Intubation, Intratracheal / Q000639:trends*; D009104:Multiple Trauma / Q000150:complications / Q000628:therapy*; D014139:Tracheostomy / Q000639:trends*