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Airway Management in Traumatic Brain Injury (TBI)

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Airway Management
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Abstract

Traumatic brain injury has become the leading cause of morbidity and mortality all over the world. Early establishment and maintenance of airway is critical as mortality increases in patients who suffer hypoxia. This review discusses the prehospital and intraoperative management of airway in these patients. The current practices and controversies regarding the use of tracheal tubes versus other means of maintaining the airway in prehospital management, indications of tracheal intubation, choice of anaesthetic drugs for induction, hemodynamic response to laryngoscopy and intubation, role of tracheostomy, as well as principles of extubation are discussed.

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References

  1. Pirvanachandra P, Hyder AA (2009) The burden of traumatic brain injury in Asia. A call for research. Pak J Neurol Sci 4:27–32

    Google Scholar 

  2. Dikmen SS, Machamer JE, Povel JM et al (2003) Outcome 3 to 5 years after moderate to severe traumatic brain injury. Arch Phys Med Rahabil 84:1449–1457

    Article  Google Scholar 

  3. Hammell CL, Hennings JD (2009) Prehospital management of severe traumatic brain injury. BMJ 338:1262–1266

    Article  Google Scholar 

  4. Murray CJ, Lopez AD (1996) Global health statistics: a compendium of incidence, prevalence and mortality estimates for over 200 conditions. Harward University Press, Cambridge

    Google Scholar 

  5. Gururaj G (2002) Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res 24:24–28

    Article  CAS  PubMed  Google Scholar 

  6. Brain Trauma Foundation (2007) Guidelines for prehospital management of traumatic brain injury. Prehospital of Emergency Case, Suppl to vol 12; 1:S1–S52

    Google Scholar 

  7. Chi JH, Knudson MM, Vanar MJ et al (2006) Pre hospital hypoxia affects outcome in patients with traumatic brain injury: a prospective multicentre study. J Trauma 61:1134–1141

    Article  PubMed  Google Scholar 

  8. Seder DB, Riker R, Jagoda A et al (2012) Emergency neurological support: airway ventilation and sedation. Neurocrit Care 17:S4–S20

    Article  PubMed  Google Scholar 

  9. Dante D, Velmahos GC (2012) Prehospital intubation for traumatic brain injury: do it correctly or not at all. ANZ J Surg 82:484–488

    Article  Google Scholar 

  10. Bukur M, Kurtovic S, Berry C et al (2011) Prehospital intubation is associated with increased mortality after traumatic brain injury. J Surg Res 170:e 117–e 121

    Google Scholar 

  11. The Brain Trauma Foundation (2000) The American Association of neurological surgeons. The joint section on neurotrauma and critical care. Initial Management J Neurotrauma 17:463–469

    Article  Google Scholar 

  12. Curry P, Viernes D, Sharma D (2011) Perioperative management of traumatic brain injury. Int J Crit Illn Inj Sci 1:27–35

    Article  PubMed Central  PubMed  Google Scholar 

  13. Goswami A, Shinde S (2013) Management of the head injured patient. Anaesthesia tutorial of the week 264. http://www.totu.anaesthesiologists.org. Accessed 30 Aug 2013

  14. Umamaheswara RGS (2005) Airway management in neurosurgical patients. Indian J Anaesth 49:336–343

    Google Scholar 

  15. Chestnut RM, Marshall LF, Klamber MR et al (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34:216

    Article  Google Scholar 

  16. Cohan P, Wang C, Mc Arthur DL et al (2005) Acute secondary adrenal insufficiency after traumatic brain injury. A prospective study. Crit Care Med 33:2358–2366

    Google Scholar 

  17. Gibbs JM (1972) The effect of intravenous ketamine on cerebrospinal fluid pressure. Br J Anaesth 44:1298–1301

    Article  CAS  PubMed  Google Scholar 

  18. Hughes S (2011) Is ketamine a viable induction agent for the trauma patient with potential brain injury. Emerg Med J 28:1076–1077

    Article  PubMed  Google Scholar 

  19. Bar-Joseph G, Guilburd Y, Guilburd J (2009) Ketamine effectively prevents intracranial pressure elevations during endotracheal tube suctioning and other distressing interventions in patients with severe traumatic brain injury. Crit Care Med 37(12 Suppl A402):90–3493

    Google Scholar 

  20. Kovarik WD, Mayberg TS, Lam AM et al (1994) Succinyl choline does not change intracranial pressure, cerebral blood flow velocity or the electroencephalogram in patients with neurological injury. Anesth Analg 78:469–473

    Article  CAS  PubMed  Google Scholar 

  21. Clancy M, Halford S, Walls R et al (2001) In patients with head injuries who undergo rapid sequence intubation using succinyl choline, does pre-treatment with competitive neuromuscular blocking agent improve outcome? A literature review. Emerg Med J 18:373–375

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. Moorthy SS, Greenspan CD, Dierdorf SF et al (1994) Increase cerebral and decreased femoral artery blood flow velocities during direct laryngoscopy and tracheal intubations. Anesth Analg 78:1144

    Article  CAS  PubMed  Google Scholar 

  23. Stein DM, Hu PF, Brenner M et al (2011) Brief episodes if intracranial hypertension and cerebral hypoperfusion are associated with poor functional outcome after severe TBI. J Trauma 71:364–374

    Article  PubMed  Google Scholar 

  24. Durward QJ, Del Maestro RF, Amacher AL et al (1983) The influence of systemic arterial pressure on the development of cerebral vasogenic edema. J Neurosurg 59:803–809

    Article  CAS  PubMed  Google Scholar 

  25. Perkins ZB, Gunning M, Crilley J et al (2013) The haemodynamic response to pre-hospital R SI in injured patients. Int J Care Injured 44:618–623

    Article  CAS  Google Scholar 

  26. Perkins ZB, Writtenberg MD, Nevin D et al (2013) The relationship between head injury severity and hemodynamic response to tracheal intubation. J Trauma Acute Surg 74:1074–1080

    Article  Google Scholar 

  27. Khan FA, ullah H (2013) Pharmacological agents for preventing morbidity associated with the haemodynamic response to tracheal intubation (Review). Cochrane Database Syst Rev 2013(7). doi: 10.1002/14651858.CD004087 (Article No: CD004087, Pub 2)

  28. Bucx MJ, Van Geel RT, Scheck PA et al (1992) Cardiovascular effects of forces applied during laryngoscopy. The importance of tracheal intubation. Anaesthesia 47:1029–1033

    Article  CAS  PubMed  Google Scholar 

  29. Dumont TM, Vision AJ, Rughain AI et al (2010) Inappropriate prehospital ventilation in severe traumatic brain injury increases in hospital mortality. J Neurotrauma 27:1233–1241

    Article  PubMed  Google Scholar 

  30. Sharma D, Vavilala MS (2012) Perioperative management of adult traumatic brain injury. Anesthesiol Clin 30:333–346

    Article  PubMed Central  PubMed  Google Scholar 

  31. De Haven CB, Jr Hurst JM, Branson RD (1986) Evaluation of two different extubation criteria: attributes contributing to success. Critical Care Med 14:82–84

    Google Scholar 

  32. Ko R, Ramos L, Chalela JA (2009) Conventtional weaning parameters do not predict extubation failure in neurocritical care patients. Neurocrit Care 10:269–273

    Article  PubMed  Google Scholar 

  33. Khamiees M (2001) Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest 120:1262–1270

    Article  CAS  PubMed  Google Scholar 

  34. Wendell LC, Kofke WA (2011) So you think you can safely extubate your patients? Neurocrit Care 15:1–3

    Article  PubMed  Google Scholar 

  35. Karanijia N, Nordquist D, Stevens R et al (2011) A clinical description of extubation failure in patients with primary brain injury. Neurocrit care 15:4–12

    Article  Google Scholar 

  36. Bouderka MA, Fakhir B, Bouaggad A et al (2004) Early tracheostomy versus prolonged endotracheal intubation in severe head injury. J Trauma 57:251–254

    Article  PubMed  Google Scholar 

  37. Pinheiro BdV, de Tostes R O, Brum eI et al (2010) Early versus late tracheostomy in patients with acute severe brain injury. J Bras Pneumol 36:84–91

    Article  PubMed  Google Scholar 

  38. Rizk EB, Patel AS, stetter CM et al (2011) Impact of tracheostomy timing on outcome after severe head injury. Neurocrit Care 15:481–489

    Google Scholar 

  39. Maziak D, Meade M, Todd T (1998) The timing of tracheotomy: a systematic review. Chest 114:605–609

    Article  CAS  PubMed  Google Scholar 

  40. Dunham C, LaMonica C (1984) Prolonged tracheal intubation in the trauma patient. J Trauma 24:120–124

    Article  CAS  PubMed  Google Scholar 

  41. Shamim MS, Qadeer M, Murtaza G et al (2011) Emergency department predictors of tracheostomy in patients with isolated traumatic brain injury requiring emergency cranial decompression. J Neuro surg 115:1007–1012

    Google Scholar 

  42. Combes X, Jabre P, Marenet A (2011) Unanticipated difficult airway management in the pre hospital emergency setting: prospective validation of an algorithm. Anesthesiology 114:105–110

    Google Scholar 

  43. Platts-Mills TF, Campagne D, Chwinock B et al (2009) A comparison of glidescope video laryngoscopy versus direct laryngoscopy intubation in the emergency department. Acad Emerg Med 16:866–871

    Google Scholar 

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Correspondence to Fauzia Anis Khan .

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© 2014 Springer International Publishing Switzerland

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Khan, F.A. (2014). Airway Management in Traumatic Brain Injury (TBI). In: Khan, Z. (eds) Airway Management. Springer, Cham. https://doi.org/10.1007/978-3-319-08578-4_9

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  • DOI: https://doi.org/10.1007/978-3-319-08578-4_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-08577-7

  • Online ISBN: 978-3-319-08578-4

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