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2018, Número S1

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Rev Cub Med Int Emerg 2018; 17 (S1)


Guías de la Difficult Airway Society (DAS) para el Manejo de la Intubación Difícil no anticipada en Adultos

Urtubia VR

Idioma: Español
Referencias bibliográficas: 315
Paginas: 1-34
Archivo PDF: 1550.54 Kb.


FRAGMENTO

Estas guías proporcionan una estrategia para el manejo de la vía aérea difícil no anticipada con intubación traqueal. Están fundamentadas en la evidencia publicada. Sin embargo, en ausencia de evidencia, han sido formuladas por opiniones de miembros de la DAS y basadas en la opinión de expertos. Estas guías han recogido los avances en la comprensión del manejo de crisis; enfatizan el reconocimiento y declaración de la presencia de dificultad en el manejo de la vía aérea. Ahora, un solo algoritmo simplificado abarca las dificultades no anticipadas y la intubación en secuencia rápida. La preparación para la intubación fallida debe formar parte de las instrucciones antes de la inducción anestésica, particularmente para la cirugía de urgencia. Se ha puesto énfasis en la eva-luación, preparación, posicionamiento, preoxige-nación, mantención de la oxigenación y en reducir la ocurrencia de lesiones derivadas de las intervenciones sobre la vía aérea. Se recomienda limitar en lo posible las intervenciones, y que las técnicas "a ciegas" usando un "bougie" o a través de dispositivos supraglóticos (DSG) sean reem-plazadas por intubación guiada con dispositivos con video o con fibra óptica. Si la intubación tra-queal falla, se recomienda usar DSG para proveer un método de oxigenación mientras se reevalúa cómo proceder. Se recomienda usar DSG de segunda generación, pues tienen ventajas sobre los de primera generación. Cuando tanto la intubación traqueal y los DSG han fracasado, des-pertar al paciente es la opción por defecto. Si en esta situación la ventilación con máscara facial en presencia de relajación muscular es imposible, se debe proceder a realizar una cricotirotomía inmediatamente. Se prefiere la cricotirotomía con bistu-rí como la técnica de rescate de elección y debe ser practicada por todos los anestesiólogos. Los planes delineados están diseñados para ser simples y fáciles de seguir. Deben ser ensayados regularmente y deben ser familiares para todo el equipo.


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