title: Traumatic airway management in Operation Iraqi Freedom.
abstract: OBJECTIVE
  To examine the role of head and neck surgeons in traumatic airway management in Operation Iraqi Freedom and to understand the lessons learned in traumatic airway management to include a simple airway triage classification that will guide surgical management.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Air Force Theater Hospital at Balad Air Base, Iraq.
  
  
  METHODS
  The traumatic airway experience of 6 otolaryngologists/head and neck surgeons deployed over a 30-month period in Iraq was retrospectively reviewed.
  
  
  RESULTS
  One hundred and ninety-six patients presented with airway compromise necessitating either intubation or placement of a surgical airway over the 30-month timeframe. Penetrating face trauma (46%) and penetrating neck trauma (31%) were the most common mechanisms of injury necessitating airway control. The traumatic airways performed include 183 tracheotomies, 3 cricothyroidotomies, 9 complicated intubations, and 1 stoma placement. Red or emergent airways were performed in 10% of patients, yellow or delayed airways in 58% of patients, and green or elective airways in 32% of patients. Lastly, surgical repair of the laryngotracheal complex was performed in 25 patients with 16 thyroid cartilage repairs, 4 cricoid repairs, and 8 tracheal repairs.
  
  
  CONCLUSIONS
  The role of the deployed otolaryngologist in traumatic airway management was crucial. Potentially lifesaving airways (red/yellow airways) were placed in 68% of the patients. The authors' recommended treatment classification should optimize future traumatic airway management by stratifying traumatic airways into red (airway less than 5 minutes), yellow (airway less than 12 hours), or green categories (airway greater than 12 hours).
authors.affiliation: Wilford Hall Medical Center, Lackland Air Force Base, Texas 78236-9908, USA. Joseph.brennan@lackland.af.mil
authors.forename: Joseph
authors.initials: J
authors.lastname: Brennan
authors.forename: Mark D
authors.initials: MD
authors.lastname: Gibbons
authors.forename: Manuel
authors.initials: M
authors.lastname: Lopez
authors.forename: David
authors.initials: D
authors.lastname: Hayes
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Faulkner
authors.forename: Robert L
authors.initials: RL
authors.lastname: Eller
authors.forename: Chester
authors.initials: C
authors.lastname: Barton
mesh_terms: D000328:Adult; D058109:Airway Management / Q000145:classification; D005151:Facial Injuries / Q000601:surgery*; D006801:Humans; D007442:Intubation, Intratracheal; D054542:Iraq War, 2003-2011; D007817:Laryngeal Cartilages / Q000293:injuries / Q000601:surgery; D008297:Male; D019838:Neck Injuries / Q000601:surgery*; D012189:Retrospective Studies; D014140:Tracheotomy; D014218:Triage; D014950:Wounds, Penetrating / Q000601:surgery*