Securing the airway to provide sufficient oxygenation and ventilation is of paramount importance in the management of all types of emergency patients. Particularly in severely injured patients, strategies should be adapted according to useful recent literature findings.
The role of out-of-hospital endotracheal intubation in patients with severe traumatic brain injury as prevention of hypoxia still persists, and the ideal neuromuscular blocking agent will be a target of research. Standardized monitoring, including capnography and the use of standardized medication protocols without etomidate, can reduce further complications. Prophylactic noninvasive ventilation may be useful for patients with blunt chest trauma without respiratory insufficiency.
An algorithm-based approach to airway management can prevent complications due to inadequate oxygenation or procedural difficulties in trauma patients; therefore, advanced equipment for handling a difficult airway is needed. After securing the airway, ventilation must be monitored by capnography, and normoventilation involving the early use of protective ventilation with low-tidal volume and moderate positive end-expiratory pressure must be the target.
After early identification of patients with blunt chest trauma at risk for respiratory failure, noninvasive ventilation might be a treatment strategy, which should be evaluated in future research.
aDepartment of Anaesthesiology
bEmergency Department, University Hospital Aachen, RWTH Aachen University
cEmergency Medical Service, Fire Department, Aachen, Germany
Correspondence to Professor Rolf Rossaint, MD, PhD, Department of Anesthesiology, University Hospital, RWTH Aachen University, Pauwelsstr. 30, D–52074 Aachen, Germany. Tel: +49 241 80 88179; fax: +49 241 80 82304; e-mail: Rrossaint@ukaachen.de