title: Use of a Supraglottic Airway to Relieve Ventilation-Impeding Gastric Insufflation During Emergency Airway Management in an Infant.
abstract: Positive-pressure bag-valve-mask ventilation during emergency airway management often results in significant gastric insufflation, which may impede adequate ventilation and oxygenation. Current-generation supraglottic airways have beneficial features, such as channels for gastric decompression while ventilation is ongoing. A 5-week-old female infant required resuscitation for hypoxemic respiratory failure caused by rhinovirus with pneumonia. Bag-valve-mask ventilation led to gastric insufflation that compromised ventilation, thereby interfering with intubation because of precipitous oxygen desaturation during laryngoscopy. A current-generation supraglottic airway (LMA Supreme; Teleflex Inc, Morrisville, NC) was used to facilitate gastric decompression while ventilation and oxygenation was ongoing. After gastric decompression, ventilation was markedly improved and the pulse oxygen saturation improved to 100%. Intubation was successful on the next attempt, without oxygen desaturation. Current-generation supraglottic airways have 3 distinct advantages compared with first-generation supraglottic airways, which make them better devices for emergency airway management: gastric decompression ports, conduits for intubation, and higher oropharyngeal leak pressures.
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN. Electronic address: kdoddmd@gmail.com.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Dodd
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; Department of Pediatrics, Division of Pediatric Emergency Medicine, Masonic Children's Hospital, University of Minnesota Medical School, Minneapolis, MN.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Strobel
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Driver
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Reardon
mesh_terms: D000388:Air; D058109:Airway Management / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods*; D017214:Laryngeal Masks; D013270:Stomach