© 2007 American Thoracic Society
Use of Preoxygenation with the Laryngeal Mask Airway in Critical CareFrom the Authors:We thank Dr. Souza and colleagues for their comments on our recent article (1). Dr. Sousa proposes that the laryngeal mask airway (LMA) could also be an intermediate approach compared with noninvasive ventilation for preoxygenation before intubation of hypoxic patients in the intensive care unit (1). The aim of preoxygenation is to avoid or delay arterial desaturation during endotracheal intubation. Even if the LMA spares laryngoscopy, we challenge the assertion that it would demand "less pharmacological modulation, resulting in a smooth induction." If the LMA is used as a preoxygenation method, its introduction per se might worsen optimal preoxygenation, as its proper use usually requires deep sedation, which leads to apnea, or at least to severe hypoventilation. We worry about the consequences of such a procedure if applied routinely. However, we do agree with Dr. Souza that the LMA is useful in many difficult situations, as in "cannot ventilate–cannot intubate" patients. The safe use of the LMA should then be restricted to situations where intubation is extremely difficult and as a rescue method in hypoxic patients requiring tracheal intubation.
Avicenne Hospital Paris 13 University–AP-HP, Bobigny, France
DAR B University Hospital of Montpellier and Saint Eloi Hospital, Montpellier University, Montpellier, France FOOTNOTES Conflict of Interest Statement: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
