Formation of an Airway Lead Network: an essential patient safety initiative.

We outline the history, implementation and clinical impact of the formation of an Airway Lead Network. Although recommendations to improve patient safety in airway management are published and revised regularly, uniform implementation of such guidelines are applied sporadically throughout the hospital and prehospital settings. The primary roles of an Airway Lead are to ensure supply, quality and storage of airway equipment, promote the use of current practice guidelines as well as the organisation of training and audits. Locally, the Airway Lead may chair a multi-disciplinary airway committee within their organisation; an Airway Lead Network enables Airway Leads to share common problems and solutions to promote optimal airway management on a national level. Support from governing bodies is an essential part of this structure.

Extubation of the Challenging or Difficult Airway.

PURPOSE OF REVIEW: This review explores relevant definitions, epidemiology, management, and potential future research directions in the extubation of the challenging/difficult airway. It provides guidance on identifying patients at risk and how to approach these clinical scenarios. RECENT FINDINGS: Based on recent literature, including large-scale audits and closed claims analysis, it is increasingly recognized that extubation of the difficult airway is a situation at risk of severe adverse events. Some strategies to manage the extubation of the challenging/difficult airway have been described. SUMMARY: Extubating the challenging/difficult airway is a high-risk situation. However, it is fundamental to keep in mind that intended extubation is always an elective procedure. As such, it is imperative to adhere to principles of careful patient and context assessment, planning, and execution only when optimal conditions have been secured.

Extracorporeal Membrane Oxygenation in a 29-Year-Old Man with Pneumocystis jirovecii Respiratory Failure and AIDS.

The use of extracorporeal membrane oxygenation (ECMO) in patients who have acute respiratory distress syndrome has been generally beneficial. However, because of various concerns, ECMO has rarely been used in patients who have human immunodeficiency virus infection with or without acquired immune deficiency syndrome. We report our successful use of venovenous ECMO in a 29-year-old man who presented with severe respiratory distress secondary to Pneumocystis jirovecii pneumonia associated with undiagnosed infection with the human immunodeficiency virus and acquired immune deficiency syndrome. After highly active antiretroviral therapy was begun, acute immune reconstitution inflammatory syndrome developed. The patient's respiratory condition deteriorated rapidly; he was placed on venovenous ECMO for 19 days and remained intubated thereafter. After a 65-day hospital stay and inpatient pulmonary rehabilitation, he recovered fully. In addition to presenting this case, we review the few previous reports and note the multidisciplinary medical and surgical support necessary to treat similar patients.