From the Guidelines
Nasopharyngeal airways should be avoided in patients with suspected or confirmed head trauma, particularly those with basilar skull fractures. The primary concern is that the tube could potentially penetrate through a fracture in the cribriform plate and enter the brain, causing catastrophic injury 1. This risk is highlighted by case reports of inadvertent intracranial placement of a nasopharyngeal airway in patients with basilar skull fractures, as noted in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Some key points to consider when assessing the risk of basilar skull fracture include:
- Raccoon eyes (periorbital ecchymosis)
- Battle's sign (bruising behind the ear)
- Cerebrospinal fluid leakage from the ears or nose
- Hemotympanum (blood behind the eardrum) In head trauma patients requiring airway management, oropharyngeal airways are generally safer alternatives if the patient has an adequate gag reflex. For patients with severe head injuries requiring advanced airway management, endotracheal intubation performed by qualified providers is typically the preferred method 1.
The use of nasopharyngeal airways in patients with head trauma is further complicated by the potential for airway bleeding, which can occur in up to 30% of patients following insertion of a nasopharyngeal airway 1. Given the potential risks and complications associated with nasopharyngeal airway use in head trauma patients, it is essential to exercise caution and consider alternative airway management strategies.
From the Research
Nasopharyngeal Airway Use in Head Trauma
- The use of nasopharyngeal airways in patients with head trauma is not recommended due to the risk of intracranial insertion, as reported in a case study from 2004 2.
- This complication can result in catastrophic consequences, including iatrogenic injury, and highlights the need for caution when managing the airway in head-injured patients.
- Alternative airway management strategies, such as oropharyngeal airways, may be used to assist with ventilation, but definitive securing of the airway through inline endotracheal intubation or surgical techniques is preferred in this patient population 2.
- A review of airway management in trauma patients, including those with head trauma, emphasizes the importance of anticipating difficulty and considering the unique challenges presented by each patient's condition 3.
- The review highlights the need for a thoughtful approach to airway management, taking into account potential anatomic and physiologic challenges, such as traumatic brain injury, suspected c-spine injury, and maxillofacial trauma 3.