Težavna dihalna pot & CICO

Za zdravstvene strokovnjake. Podatki ne nadomeščajo zdravniške presoje v posameznem primeru; merodajna sta veljavni povzetek glavnih značilnosti zdravila in navedene smernice.

Zdravniško pregledano: Dr. med. univ. Daniel Pehböck, DESA, 03.11.2026

Težavna dihalna pot & CICO: Napoved – pred vsakim uvodom, Fiziološko težavna dihalna pot – „Resuscitate before you intubate“, Preoksigenacija in apnoična oksigenacija, Načrti A–D podrobno (DAS 2025), Relaksacija pri CICO, eFONA: skalpel – bougie – tubus (odrasli, otroci od pribl. 8 let) – jedrnato za ekipe nujne medicine, anesteziologije in intenzivne terapije, z viri in zdravniško pregledano.

Vsebina poglavja

1. Napoved – pred vsakim uvodom
2. Fiziološko težavna dihalna pot – „Resuscitate before you intubate“
3. Preoksigenacija in apnoična oksigenacija
4. Načrti A–D podrobno (DAS 2025)
5. Relaksacija pri CICO
6. eFONA: skalpel – bougie – tubus (odrasli, otroci od pribl. 8 let)
7. Otroci, mlajši od pribl. 8 let
8. Vortex – tri življenjske linije
9. Komunikacija
10. Po oskrbi dihalne poti

Učinkovine v tem poglavju

• Rokuronij
• Sugamadeks

Viri in smernice

1. Ahmad I et al. Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults. Br J Anaesth 2026;136(1):283–307 (Epub 07.11.2025, PubMed 41203471), Algorithmus Plan A–D.
2. Frerk C, Mitchell VS, McNarry AF et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015;115:827–848 (Vorgängerfassung; Einzelschritte Skalpell.
3. Piepho T, Kriege M, Byhahn C, Cavus E, Dörges V, Ilper H et al. S1-Leitlinie Atemwegsmanagement 2023 (DGAI), AWMF-Register 001-028, Version 2023-09, gültig ab 21.08.2023 für 5 Jahre. Anästh Intensivmed 2024;65:69–96.
4. Timmermann A, Böttiger BW, Byhahn C et al. S1-Leitlinie Prähospitales Atemwegsmanagement (Kurzfassung), DGAI-Beschluss 25.02.2019, AWMF-Register 001-040. Anästh Intensivmed 2019;60:316–336.
5. Bernhard M, Bein B, Böttiger BW et al. Handlungsempfehlung Prähospitale Notfallnarkose beim Erwachsenen (DGAI, S1), 2015 (Anästh Intensivmed bzw. Notfall Rettungsmed 2015)
6. Apfelbaum JL, Hagberg CA, Connis RT et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology 2022;136:31–81.
7. Ahmad I, El-Boghdadly K, Bhagrath R et al. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia 2020;75:509–528.
8. Higgs A, McGrath BA, Goddard C et al. (DAS, ICS, FICM, RCoA). Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth 2018;120:323–352.
9. Mushambi MC, Kinsella SM, Popat M et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics. Anaesthesia 2015;70:1286–1306.
10. The Protected Airway: DAS 2025 Update.
11. Mosier JM, Joshi R, Hypes C et al. The physiologically difficult airway. West J Emerg Med 2015;16:1109–1117.
12. Kornas RL, Owyang CG, Sakles JC, Foley LJ, Mosier JM (Society for Airway Management's Special Projects Committee). Evaluation and management of the physiologically difficult airway.
13. Karamchandani K et al. (SOCCA Physiologically Difficult Airway Task Force). Tracheal intubation in critically ill adults with a physiologically difficult airway. An international Delphi study. Intensive Care Med 2024;50:1563–1579.
14. Gibbs KW, Semler MW, Driver BE et al. (PREOXI). Noninvasive ventilation for preoxygenation during emergency intubation. N Engl J Med 2024;390:2165–2177.
15. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med 2012;59:165–175 (apnoische Oxygenierung über Nasenbrille 15 l/min).
16. Chrimes N, Higgs A, Hagberg CA et al. Preventing unrecognised oesophageal intubation.
17. Chrimes N. The Vortex.
18. Brown CA III, Sakles JC, Mick NW et al. (Hrsg.). The Walls Manual of Emergency Airway Management, aktuelle Auflage, Wolters Kluwer.
19. Association of Paediatric Anaesthetists of Great Britain and Ireland (APA) und Difficult Airway Society. Paediatric difficult airway guidelines (2012; Algorithmen für Kinder von 1–8 Jahren inkl. CICO mit Kanülen-Krikothyreotomie); Black AE, Flynn PER, Smith HL, Thomas ML, Wilkinson KA. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth 2015;25:346–362.
20. All India Difficult Airway Association 2025 guidelines for the management of unanticipated difficult airway in paediatrics under general anaesthesia. Indian J Anaesth 2025 (11/2025)
21. Übersichtsarbeit zur Notfall-Koniotomie (eFONA) bei Kindern. Front Disaster Emerg Med 2026.
22. Life in the Fast Lane (LITFL). Airway.
23. Soar J, Böttiger BW et al. European Resuscitation Council Guidelines 2025 Adult Advanced Life Support. Resuscitation 2025;215 Suppl 1:110769 (Korrigendum 2026).
24. Djakow J, Turner NM, Skellett S et al. European Resuscitation Council Guidelines 2025 Paediatric Life Support. Resuscitation 2025;215 Suppl 1:110767.
25. Povzetki glavnih značilnosti odobrenih zdravil – zdravilo in poglavje pri vsakem odmerku v aplikaciji.