每个急诊科都应配备两种类型的声门上气道装置：喉罩气道失败后的喉管救援：两例病例系列

文献信息

中文摘要

背景： 声门上气道（SGA）是急诊气道管理中的关键救援装置，可在大多数插管失败的情况下提供有效的氧合。当前的气道算法建议配备声门上气道，但未区分装置类别。喉罩式声门上气道在声门入口上方形成喉周密封，而喉管式装置则通过双套囊形成下咽部密封。由于这些装置在不同解剖位置形成密封，它们可能因不同原因而失败。
病例报告： 我们报告了两例急诊科病例，其中喉罩式声门上气道通气失败，但在放置喉管式装置后立即成功。在第一例中，一名先前未被识别的Klippel-Feil综合征患者在插管失败且通过喉罩式装置通气无效后出现低氧血症；使用喉管恢复了氧合，避免了外科气道。在第二例中，一名颈部穿透伤患者尽管重新调整位置，仍无法通过喉罩式装置进行通气，但使用喉管立即成功通气，从而得以控制性插管。为什么急诊医师应了解这一点？：这些病例表明，声门上气道并非可互换，配备不止一种类型的装置可能为气道救援提供重要的安全余地。

英文摘要

BACKGROUND: Supraglottic airways (SGAs) are critical rescue devices in emergency airway management and provide effective oxygenation in most failed intubations. Current airway algorithms recommend availability of a supraglottic airway but do not distinguish between device classes. Laryngeal mask-style SGAs create a perilaryngeal seal over the glottic inlet, whereas laryngeal tube-style devices create a hypopharyngeal seal with dual cuffs. Because these devices seal in different anatomic locations, they may fail for different reasons.
CASE REPORTS: We report two emergency department cases in which ventilation failed with a laryngeal mask-style SGA but succeeded immediately after placement of a laryngeal tube-style device. In the first case, a patient with previously unrecognized Klippel-Feil syndrome developed hypoxemia after failed intubation and ineffective ventilation through a laryngeal mask-style device; oxygenation was restored with a laryngeal tube, avoiding surgical airway. In the second case, a patient with penetrating neck trauma could not be ventilated with a laryngeal mask-style device despite repositioning, but ventilation was immediately successful with a laryngeal tube, allowing controlled intubation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: These cases suggest that supraglottic airways are not interchangeable and that access to more than one device class may provide an important safety margin during airway rescue.