Präklinische Anwendung des Larynxtubus

Zusammenfassung

Der Larynxtubus (LT) gewinnt zunehmend auch in der Notfallmedizin an Bedeutung. Es wird über 2 Patienten berichtet, bei denen es im Rahmen einer präklinischen Atemwegssicherung mithilfe des LT zu einer schwerwiegenden Aspiration bzw. einer gastralen Luftinsufflation mit Unmöglichkeit der Beatmung kam. Die zu diesen Ereignissen führenden Pathomechanismen, deren Erkennung und Behebung werden diskutiert.

Abstract

Laryngeal tubes (LT) are increasingly being used for emergency airway management. This article reports on two patients in whom out-of-hospital intubation with a single-lumen LT was associated with massive pulmonary aspiration in one patient and gastric overinflation in the other. In both cases peak inspiratory pressures exceeded the LT leak pressure of approximately 35 mbar. This resulted in gastric inflation and decreased pulmonary compliance and increased inspiratory pressure further, thereby creating a vicious circle. It is therefore recommended that laryngeal tube suction (LTS) should be used in all cases of emergency airway management and a gastric drain tube be inserted through the dedicated second lumen. Apart from gastric overinflation, incorrect LT/LTS placement must be detected and immediately corrected, e.g. in cases of difficult or impossible gastric tube placement, permanent drainage of air from the gastric tube, decreasing minute ventilation or an ascending capnography curve.