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Published on: June 6, 2020
Airway algorithm for the management of patients with a King LT
Sobia F Khaja1, Kristi E Chang
1Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinic, Iowa City, Iowa, U.S.A.
Insights
This case series proposes an algorithm for managing patients with a King LT airway device. The algorithm aims to improve outcomes and minimize tracheostomy in these complex airway cases.
Area of Science:
- Emergency Medicine
- Anesthesiology
- Otolaryngology
Background:
- The King LT is a supraglottic airway device used for temporary airway management.
- Patients presenting with a King LT in place can pose significant airway management challenges.
- A structured approach is needed to optimize outcomes in these patients.
Purpose of the Study:
- To present an algorithm for the management of patients with a King LT device.
- To improve the safety and efficacy of airway management in this patient population.
- To reduce the incidence of complications, such as tracheostomy.
Main Methods:
- Retrospective case series of three patients presenting with a King LT.
- Review of clinical history and hospital course.
- Development of a management algorithm based on case experiences.
Main Results:
- Two of three patients were successfully intubated.
- One patient required tracheostomy for definitive airway management.
- The proposed algorithm includes flexible endoscopy, Seldinger technique intubation, or video laryngoscopy.
Conclusions:
- The King LT is a useful temporary airway device.
- An evidence-based algorithm is crucial for otolaryngologists managing King LT airways.
- Effective airway management can minimize the need for tracheostomy.
Objectives/Hypothesis:
To discuss an algorithm for managing the airway in patients presenting with a King LT in place.
Study Design:
Case series at a single institution with planned chart review.
Methods:
This study reviewed the management of three patients who presented to a tertiary academic medical facility emergency department following placement of a King LT at an outside hospital or in the field. Clinical history at admission as well as each patient's hospital course was evaluated. We discuss the management of the airway in each of these cases and use these to help design an algorithm for improving outcomes in patients with a King LT in place.
Results:
In each of the three cases presented, the Otolaryngology Department was consulted for definitive airway management. In two of these patients, the airway was successfully secured using endotracheal intubation. Only one patient required tracheostomy. We discuss an algorithm for managing these patients to obtain a safe airway, which includes assessing the airway with flexible endoscopy and then proceeding with intubation by the Seldinger technique or intubation using a video laryngoscope. In some cases, tracheostomy will be required to definitively secure the airway.
Conclusions:
The King LT is a valuable tool available in the field to help to temporarily secure the airway. Otolaryngologists should have an appropriate airway algorithm for managing patients with a King LT in place to minimize the need for a tracheostomy.
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