Timing of tracheal intubation in traumatic cardiac tamponade: a word of caution.
Airway, breathing, and circulation are top priorities in any resuscitation. However, in cardiac tamponade, the decision to intubate the trachea and initiate positive pressure ventilation (PPV) should only be taken after consideration of the deleterious haemodynamic effects of positive intrathoracic pressure. We suggest that the threshold for intubation and PPV should be raised in tamponade and that intubation and PPV should, if possible, be timed so that relief of tamponade can immediately follow. In the trauma setting, emergency thoracotomy is the best approach. When intubation is unavoidable because of very low oxygen saturation or cardiac arrest, high ventilatory pressures should be avoided.
Ho
Anthony M-H
AM
Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China. hoamh@yahoo.com
Graham
Colin A
CA
Ng
Calvin S H
CS
Yeung
Janice H H
JH
Dion
Peter W
PW
Critchley
Lester A H
LA
Karmakar
Manoj K
MK
D000465:Algorithms; D001794:Blood Pressure; D002305:Cardiac Tamponade / Q000209:etiology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020519:Pericardiocentesis; D011175:Positive-Pressure Respiration; D014951:Wounds, Stab / Q000150:complications