Ideal Qualities of Airway Management Devices and Systems

ideal airway mgmt

Ideal Qualities of Airway Management Devices and Systems

In this day and age of modern innovation, it’s hard to envision the world of airway management of the not so distant past. These innovations have not only changed the landscape of medicine but have contributed to saving lives with greater safety. Who would argue the importance of such things as capnography, pulse oximetry, laryngeal airway masks and video laryngoscopes? Yet as airway management and innovation have progressed, what is the new paradigm? What is the next path that we as airway management specialists need to take? Where is the next horizon? What is the dream? Our present-day devices have flaws in their inherent design. Many of them were invented nearly 80 years ago. I have devised a so-called wish list of the most ideal attributes of an airway management device. Let’s free ourselves from the nonsense of a brighter laryngoscope blade, measuring airway cuffed pressure or uncuffed laryngeal airway masks. I’m not saying these discussions have no place in airway management. What I am trying to elucidate is where we should be going now as we carry on into the future. What are the attributes of the most ideal airway management device or system? This is my list and I invite you to think of more:

  • Ease of usability by greatly reducing the skill set required to rescue an airway for ventilation or intubation.
  • The ability to easily ventilate and intubate with continued visualization.
  • The ability to diagnose silent aspiration the present day.
  • The ability to intubate with no trauma to the airway.
  • The ability to intubate easily and less stimulating during an awake intubation scenario.
  • The ability to intubate without muscle relaxants.
  • The ability to extubate and emergently reintubate rapidly and easily.
  • The ability to continually monitor heart tones and quality of breath sounds.
  • The ability to convey on site parameters of visualization, heart tones, temperature, etc. to other remote sites in real time.
  • The ability to maintain a patient’s airway and easily convert to intubation and extubation as you choose under continued visualization.
  • Continued visualization of glottis and periglottic structures.
  • Lessening or preventing aspiration.
  • An access port for gastric tube placement.
  • The ability to verify that an endotracheal tube is placed correctly.
  • The ability to visualize the glottis and periglottic structures while suctioning.
  • The ability to intubate and provide positive pressure ventilation during intubation.
  • The ability to eliminate bucking on an endotracheal tube during extubation.
  • The ability to provide supraglottic ventilation, stenting the airway opening in an easy fashion.

What is your list? Can we push a new narrative as to what we as airway specialists would want? Making things safer and easier with continued visualization would be a good start. With the advent of self-driving vehicles, drones and cameras with wireless communications in toys, what will the next new innovation be in airway management? I would speculate that like all technologies it should make things easier, safer and more communicative to the patient and medical professional. Advancements in electronics, plastics and camera technologies are directly responsible for the main innovations used in airway management today. Training programs adapted these new technologies, advancing this knowledge to their trainees. These technologies have empowered individuals of all skill sets to undertake airway management who have previously had less training in the space. From expert to novice, all have improved successes in airway management. All individuals who practice airway management can contribute to designing the next generation of devices. We all have the ideas and dreams of what would make airway management simpler, easier and more successful.

It is time for this journey to begin.

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