Transcript AIRTRAQ - Timeoutintensiva

AIRTRAQ
LARYNGOSCOPE
February 2007
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Airtraq Optical Laryngoscope
Index
1. Introduction to Airway Management
2. Airtraq Features & Design Characteristics
3. Clinical Experience & Feedback
4. Instructions for Use / Tips / Airtraq Sizes
5. Video System description
6. Distribution. Present status.
7. Training Material
8. When and where to use it. Alternative devices.
9. How to start using the Airtraq
10. Manekin Practice
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Glottis Anatomy
Epiglottis
Vocal cords
Arytenoids
Esophagus
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Tracheal Intubation
Alignment of 3 axes
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Direct Laringoscopy
Macintosh blade
Miller blade
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Direct Laryngoscopy
examples of what is usually seen
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Direct Laryngoscopy
examples of what is usually seen
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Airway Classification
Cormack – Lehane Grade
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Airway Classification
Mallampati Class
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University of Florida Statements
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University of Florida Statements
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University of Florida Statements
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University of Florida Statements
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Airtraq Features
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Airtraq is a new intubation device, developed, and
patented by Dr. Acha. It offers:
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Full visualization of the airway, during 100% of the
laryngoscopic procedure, facilitating tracheal intubation
and avoiding esophageal and bronchial intubations
No hyperextension of the neck required
Allows intubation of patients in any position, e.g., sitting,
allowing the clinician optimal access with respect to the
patient
Easy to use
Short learning cycle
Versatile. Broad field of applications.
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Airtraq Design Characteristics
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Anatomically shaped
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High quality optical system in separate visualization
channel
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Guide channel for insertion of the endotracheal tube
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Anti-fog system for optics
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Light source ( low temperature ) for illuminating the
anatomy
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Single use device
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Uses any standard endotracheal tube
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Two sizes (plus paediatric in 2008).
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Available clip-on video system to allow viewing on an
external screen
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AIRTRAQ Optical Laryngoscope
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Airtraq Detailed Description
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1. Viewfinder
2. Optical Duct
3. Rubber Viewfinder
4. ET Channel
5. Battery box
6. Light (LED)
7. Switch
8. Anti-fog system
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Optics and View
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Developed with Spanish Navy – eye glass quality, but disposable
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The “View”
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Optics and guiding channel “point” the user to the
center of the viewing window.
The user only has to center the vocal cords in the
middle of the image and the ETT goes in.
Glottis
ETT
Optics
Viewer
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University of Florida Statements
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Airtraq Laryngoscope
Clinical Testing through January 2007
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More than 5,000 succesful intubations
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All Cormack III and IV patients became Cormack I, II
using the Airtraq
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Male and female from 36 kg to over 150 kg all intubated
with the regular size
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Morbidly obese patients
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Intubations without muscle relaxants
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Frontal intubations with patient in the upright and
sitting position
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Intubations of awake patients
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Emergency intubations of severely injured patients
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Results 1st Study - University of Ireland
Results.
The Airtraq® proved easy to learn and performed similarly to the Macintosh
laryngoscope in the normal airway.
Initially, tracheal intubation of the normal airway took significantly longer with
the Airtraq device, but this was eliminated at the end of the protocol,
illustrating a steep learning curve.
In simulated difficult airway scenarios, the Airtraq® proved easier to use,
resulted in less dental trauma, and had greater success in tracheal
intubation than the Macintosh Laryngoscope.
Conclusions.
This manikin study demonstrates that the Airtraq® performs comparably to the
Macintosh laryngoscope in the normal airway, when used by experienced
anaesthetists.
The Airtraq® appears to hold particular promise for the management of the
difficult airway.
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Airtraq – Feedback from Anesthesiologists
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T. N., MD, FACEP. Associate Residency Director. USA
University:
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“I had the opportunity to use the Airtraq - a potentially difficult airway - obese
endstage liver and renal dz. Intubation was very smooth, quick visualization
and then was able to ventilate while watching the tube position during removal.
I'd love to get more of these - and really love to get the camera!”
N. G., MD, Univ. Graduate Research Professor USA
University
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“You can add me to the list of people who are airtraq coverts. last night had a
mal 1 airway , small chin, great opening, able to bite upper lip, normal
dentition. Couldn’t visualize with either mac or miller [blade] attempts. I got an
air traq from my locker and a novice used it and it passed what I call the "oh
wow" test. Both residents were impressed as was I. It was my first unexpected
difficult airway where I have put the device to good use.”
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Airtraq – Feedback from Anesthesiologists
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Dr. M.W., FRCA Consultant Anaesthetist , UK Major
Hospital
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“I am sure that the Airtraq device is going to be a great success and hope that I
will be able to be associated with the product”
Dr. C. M., Consultant Anaesthetist , Ireland.
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“Yesterday, I did a nasal intubation on an adult, handicapped patient with a
documented difficult airway. I could not blindly pass the ETT through the nose,
so I had to use the Macintosh laryngoscope. Well, she was a Mallampatti grade
IV and a Cormac-Lehane grade IV. I could not see a thing with the Macintosh not even the epiglottis. Well, with the Airtraq, it simply and smoothly gave me a
grade I Cormac-Lehane view. I did not have to use any force or upward lifting
manoeuvres whatsoever. The Airtraq then guided me in the placement of the
nasal tube - no problem at all !! Again, this reinforces how amazing this device
is”
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Airtraq – Feedback
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S.H., Intensive Care Paramedic , Australia:
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I've just used the Airtraq (regular size) successfully in
the field on a difficult airway, 12 year child hit by a
car, severe trauma, cervical spine immobilisation,
funny mouth and teeth, the tube went in first
attempt with the Airtraq, great visualisation and very
reassuring to actually see the tube in there and to be
able to go back and check with that great view of
everything glottic.
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5. Airtraq Laryngoscope -Instructions for Use
I. PREPARATION
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Turn ON the light. Wait until the light stops blinking
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Lubricate the ET tube and place it into the lateral channel with its tip aligned with
the end of the lateral channel of the Airtraq
II. AIRTRAQ PLACEMENT
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Insert the Airtraq into the midline of the patient´s mouth, taking care to keep aside
the tongue so that it does not falls into the mouth
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Slide the Airtraq through the oropharynx and larynx, keeping it in the midline
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Look through the eyepiece to view the airway and to identify structures
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Continue insertion until you see the epiglotis and the vocal cords
III. ET Tube INSERTION
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Advance the ET Tube by pushing it until you see the ET tube as it passes through
the vocal cords
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Verify ET tube placement and insertion length.
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Inflate the ET tube cuff, connect the ET tube to the breathing circuit and verify
placement and seal.
IV. AIRTRAQ EXTRACTION
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Separate the ET tube from the Airtraq by pulling it laterally. Make sure to hold ET
tube while sliding the Airtraq backwards.
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Make sure that the ET tube has not moved and remains properly positioned.
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Tips to maximize AIRTRAQ effectiveness.
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Insert and slide the Airtraq softly and slowly.
Keep the tongue aside
Always keep the Airtraq on the mouth´s midline.
In case structures (arytenoids, epiglottis, etc.) are not recognized, WITHDRAW the
Airtraq slightly.
Do not introduce the Airtraq too deep. If the ETT hits the arytenoids, epiglottis or
goes to the esophagus WITHDRAW the Airtraq by rotating it back.
Once the tip is located in the vallecula, gently LIFT UP the Airtraq (do not tilt or use
a lever action).
To expose the vocal cords, the tip of the Airtraq can be located either in the vallecula
(Macintosh style), or under the epiglottis (Miller style).
TWIST the Airtraq to CENTRE the vocal cords in the image.
Advance the ETT slowly without twisting it.
In case the ETT hits the arytenoids withdraw slightly the Airtraq and advance gently
again the ETT.
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How to select the appropiate Airtraq
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Works with any type of ETT
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Standard
Reinforced (wired)
Pre-shaped
Regular Size : Minimum mouth opening 18 mm
Can fit patients from 40 kg to 200 kg.
 Can be used always that the mouth can open up to two
fingers.
 ETT sizes: 8.5 / 8.0 / 7.5 /7.0 (6.5/6.0) Up to 8.5
 Small Size : Minimum mouth opening 16 mm
 First Choice for small adults or adolescents. Can fit patients
from 25 kg to 100 kg.
 ETT sizes: 7.5 / 7.0 / 6.5 / 6.0 Up to 7.5
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Airtraq – Video System
Perfect for teaching and training
Works as an optional accessory for the Airtraq
Reusable. Wireless or wired operation.
It should be mounted on top of the Airtraq after removing the original
rubber viewfinder (a simple and quick operation)
The Video System has to main devices:
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Clip-on Camera (can be connected through a cable to any monitor)
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Wireless Receiver (optional)
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Camera: with rechargeable Li-Ion Battery and wireless 2.4 GHz emitter.
Video Cable: to connect the Camera to an external monitor.
RCA / BCN Adaptor :needed to connect to most monitors in OR
Camera stand-alone battery charger
Wireless Receiver: 2.4 GHz Receiver with rechargeable Li-Ion battery and
a battery charger that can recharge the batteries of both Receiver and
camera.
Camera Battery Charge Cable: to charge the Li-Ion Battery of the Camera
from the Receiver
Power Cable
Allows to record the images into a laptop or DVD recorder.
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Airtraq – Training material
Brochure
 Videos
 DVD
 Web Site
 Email
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www.airtraq.com
[email protected]
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Countries where the Airtraq is used
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Europe :
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Germany
France
UK
Italy
Spain
Netherlands
Belgium
Switzerland
Austria
Ireland
Finland
Portugal
Eslovenia
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America:
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USA
Canada
Argentina
Chile
Venezuela
Perú
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Others :
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Japan
Korea
Australia
New Zealand
Saudi Arabia
Kuwait
United Emirates
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Airtraq – When and where to use it
“Challenging” intubations
Any anticipated difficult airway
Unanticipated Cormack III and IV patients
Infectious patients
Obese patients
Cervical Trauma
Other uses
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Emergency settings
Cervical spine immobilization
ICU ET tube exchange
Double lumen ETT Intubation
Nasotracheal Intubations
Fibroscope and Gastroscope guidance
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Alternative devices
Device
Glidescope
Disadvantages
Reusable , Requires investment , Does not guide the ETT,
Usually needs some hyperextension, Needs Set up
LMA
Blind, No intubation, risk of bronchoaspiration
Fastrack
Blind intubation, Reusable, Slow learning curve, needs special ETT
C-Trach
Reusable, Requires investment , ETT blocks vocal cords view
Poor quality image, Needs set up, Slow learning curve,
Needs special ETT
Mcgrath
Requires investment , Does not guide the ETT, No anti fog system.
Needs some hyperextension, Small scrren.
Fibroscope
Requires investment , Reusable, Needs continuos training,
Slow learning curve, Requires Set up, Clening and maintenence costs.
Upsher, etc
Reusable, Requires investment , Fiberoptics parallel to ETT trajectory
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How to start using the Airtraq
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Read instructions for use
View videos
Review tips for effectiveness.
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Remenber that most of first users tend to introduce the
Airtraq too deep inside.
Always lift up the Airtraq to obtain a full exposure of the
Airtraq
If possible intubate a manekin
Try to use the Video System for the initial intubations.
Start with easy airway patients
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Manekin practice
 Most manekins do not replicate well the Airway anatomy.
 There are special Demo Airtraqs in order to work in
manekins. The antifog system is deactivated so that the batteries last
longer.
Exercises with manekin
1. Introduce the Airtraq and look before it gets vertical. Keep advancing
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while looking through the viewfinder
Withdraw and advance the Airtraq while looking.
Place the blade of the airtraq in the vallecula and under the epiglottis
Advance and withdraw the ETT.
Advance the ETT and pinge both arytenoids by twisting the Airtraq clock
and anticlokwise.
Withdraw the Airtraq slightly and see how the ETT avoids the arytenoids
and aligns with the vocal cords.
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