Question 22

College Answer

The Laryngeal Mask Airway has a number of potential roles in the ICU:

•    Most important role is as part of the difficult airway algorithm (use to ventilate when cannot intubate; easily taught, good success rate, buys time)

•    Can be used as a conduit for bronchoscopy and/or intubation in a patient who is difficult to intubate

•    Could be  considered as  part  of  cardiac arrest  management as  an  alternative in establishing airway and ventilation by practitioners not expert in the use of the endotracheal tube

•    Can  be  used  to  maintain  airway  and  ventilation  during  the  performance  of  a percutaneous tracheotomy

•    As an alternative airway during procedures in the ICU

Other variations have been developed (including the intubating laryngeal mask, which is one of the techniques that could be used for the patient who is difficult to intubate).

Discussion

The above list is almost complete.

In summary, the ICU uses of the LMA are:

• As a backup for "can't intubate, cant ventilate" scenarios
• You can intubate though it
• You can pass a bronchoscope through it for tracheostomy
• You can temporarily ventilate somebody during a procedure
• You can use it during an arrest instead of an ETT, if skilled staff are not available