Thread by @CHESTCritCare

First up: Props to #CHEST2020 learning partners for that amazing wait music. Ne'er been a fan of wait music. But this is ... well .. peppy. Am in the mood to learn about #AirwayManagement!

Speakers: @Chaeface @J_Mendelson_MD @KDoerschug

Coverage: @virenkaul

#CHESTCritCare

https://twitter.com/virenkaul/status/1318204130167488512

.@J_Mendelson_MD: HFNC and proning in severe hypoxic resp failure:

- Can reduce dead space ventilation, assist with WOB, improved resp mechanics
- Pre-COVID data: Can be successful in potentially preventing invasive ventilation vs NIV and low flow O2

#CHEST2020 #CHESTCritCare

.@Chaeface: Pre-oxygenation modifications to reduce aerosolization

Use V-E technique vs C-E technique for rescue BMV. Improved efficacy for ventilation and better seal. (Lower picture): bit.ly/2H5aY7a

#CHEST2020 #COVID19

.@Chaeface: The "intubating box":
- Increase intubation times, exposed patients to hypoxia, esp being critically ill from #COVID19
- Breached PPE
- Increased cognitive load
- Not advised

Ref: Begley et al: bit.ly/35skLwf

#CHEST2020 #CHESTCritCare

.@KDoerschug: In #COVID19, advised intubating practices:
- Use videolaryngoscopy
- Avoid flexible / direct laryngoscopy
- Use HME filter on the bag-mask apparatus

Consensus guidelines for airway mgmt in #COVID19: bit.ly/3dDhWfr

#CHESTCritCare #CHEST2020

Dr. Dushay: Guidelines based care while ensuring minimum exposure to operator during #COVID19. Avoid extraglottic airway use, fiberoptic intubation

Re: Paralytic use: Favor use of high dose Roc to allow first-pass success +depth of paralysis to perform a safe RSI

#CHEST2020

Tips to airway success:
- Have plan A, B, C and D
- Clearly assigning roles and close looped communication
- Basics: OPA/NPA use, BMV: Revert to safety with them
- #COVID19: Use most experienced provider to ensure first-pass success

#CHEST2020

.@J_Mendelson_MD: Failed difficult airway algorithm
- Stop further attempts, just work to ventilate (BMV!)
- Supraglottic airways: Can be inserted successfully in < 30 sec in > 90% times
- Refer to and know the failed algorithm

#CHEST2020

DAS guidelines: bit.ly/3o2FleW

.@Chaeface: SGA established after failed attempt. Now?
- Adequate sedation/paralysis
- Modality: Intubating SGA w/ flexible scope vs. Salvage DL + consider bougie vs. Cont ventilation via SGA
- All fails/not ideal: Tracheostomy

ALWAYS ASK FOR HELP!

#CHEST2020 #CHESTCritCare