Airway management – where are we today?

Autori:

Morena Milić, Tatjana Goranović, Ana Brundula, Ivo Jurišić, Perislav Lauš, Iva Smiljanić

Sažetak
Uspostaviti i održati dišni put jedna je od najvažnijih interesnih točaka anesteziologa, no još u dalekoj prošlosti već su i „obični ljudi“ shvatili koliko je važno očuvati dišni put. Tako je krenuo dug i fascinantan put tijekom kojega se su se progresivno razvijala pomagala i tehnike namijenjene očuvanju dišnog puta, kao i svijest o važnosti njegovog očuvanja. Od prvih traheotomija tisuću godina prije Krista, preko direktne laringoskopije i ventilacije bolesnika uz pomoć modernih anestezioloških aparata, došli smo do ere raznih videopomagala: stileta, rigidnih i fleksibilnih bronhoskopa, videolaringoskopa i tako dalje. Veliku ulogu imalo je osvještavanje problema, brojne analize grešaka koje smo kao struka nehotice ostavljali iza sebe tijekom silnih pokušaja i promašaja u nastojanju da učinimo najbolje što možemo za bolesnika. Zahvaljujući tomu i enormnom tehnološkom napretku u zadnjih dvjesto godina, možemo reći da je došlo do revolucije u održavanju dišnog puta. Izazovi u prošlosti naučili su nas mnogo. Međutim, tijekom još uvijek aktualne pandemije COVID-19, opet smo se susreli s novim izazovima dišnog puta, ali iako nitko nije mogao ni približno zamisliti što nas čeka snašli smo se. Za razliku od uobičajenog načina na koji inače radimo u operacijskim dvoranama i jedinicama intenzivne skrbi, vodeći računa o sigurnosti bolesnikova dišnog puta ovaj smo put morali paziti i na to da zaštitimo svoj.
Summary

To secure and safely manage the airway is one of the crucial points of interest for an anesthesiologist. Already in the distant past even „common people“ quickly realized how important the airway really is. The long and fascinating journey started, along which many devices and technologies were developed. They were all dedicated to management of the airway and raising awareness of airway importance. From tracheotomies which were performed a thousand years before Christ, over first direct laryngoscopies and ventilating patients with modern ventilators, we reached the modern era with a variety of helping devices: stylets, rigid and flexible bronchoscopes, videolaryngoscopes, etc. Raising awareness among anesthesiologists also played a big role, together with numerous analyses of the mistakes we involuntarily made as professionals – during all attempts and failures to do the best we can for the patient. All that, and the enormous technological improvements during the last 200 years, resulted in a revolution in the airway management. The past taught us a lot. However, a still ongoing COVID pandemic confronted us again with new airway challenges. Although no one could ever have imagined the scenario that we had to go through, we managed. Unlike how we usually work in operating theaters and intensive care units, considering the airway safety, this time we had to think of protecting not only the patient’s airway, but ours as well.