Health education
Airway management using ultrasound
El uso del ultrasonido en el manejo de la vía aérea
Mario Andres Zamudio-Burbanoa, Fabian David Casas-Arroyaveb,
Corresponding author
fabiandavid68@yahoo.com
Corresponding author at: Calle 64 No. 51 D-154, Hospital Universitario San Vicente Fundación, Medellín, Colombia.
Corresponding author at: Calle 64 No. 51 D-154, Hospital Universitario San Vicente Fundación, Medellín, Colombia.
a Resident of Anesthesiology and Resuscitation, Member of the Difficult Airway Team, Universidad de Antioquia, Medellín, Colombia
b Anesthesiologist, Hospital Universitario San Vicente Fundación, University Hospital San Vicente Foundation, Professor at the Anesthesiology Department, Universidad de Antioquia, Medellín, Colombia
Read
8505
Timeswas read the article
1622
Total PDF
6883
Total HTML
Share statistics
array:24 [ "pii" => "S2256208715000334" "issn" => "22562087" "doi" => "10.1016/j.rcae.2015.03.008" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "215" "copyrightAnyo" => "2015" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Colomb Anestesiol. 2015;43:307-13" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1845 "formatos" => array:3 [ "EPUB" => 87 "HTML" => 1390 "PDF" => 368 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0120334715000398" "issn" => "01203347" "doi" => "10.1016/j.rca.2015.03.008" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "215" "copyright" => "Sociedad Colombiana de Anestesiología y Reanimación" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Colomb Anestesiol. 2015;43:307-13" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6348 "formatos" => array:3 [ "EPUB" => 102 "HTML" => 5105 "PDF" => 1141 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Educación en salud</span>" "titulo" => "El uso del ultrasonido en el manejo de la vía aérea" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "307" "paginaFinal" => "313" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Airway management using ultrasound" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figura 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 493 "Ancho" => 1286 "Tamanyo" => 55275 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Vista longitudinal de la tráquea. Se aprecia el tubo endotraqueal (d), la membrana cricotiroidea (c), el cartílago cricoides (b) y los anillos traqueales (a). Note el contraste con la visión del tubo endotraqueal (e) en vista axial de la tráquea.</p> <p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Fuente: autores.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Mario Andres Zamudio-Burbano, Fabian David Casas-Arroyave" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Mario Andres" "apellidos" => "Zamudio-Burbano" ] 1 => array:2 [ "nombre" => "Fabian David" "apellidos" => "Casas-Arroyave" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2256208715000334" "doi" => "10.1016/j.rcae.2015.03.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000334?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334715000398?idApp=UINPBA00004N" "url" => "/01203347/0000004300000004/v1_201510300044/S0120334715000398/v1_201510300044/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2256208715000346" "issn" => "22562087" "doi" => "10.1016/j.rcae.2015.04.006" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "216" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "ssu" "cita" => "Rev Colomb Anestesiol. 2015;43:314-20" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2179 "formatos" => array:3 [ "EPUB" => 92 "HTML" => 1770 "PDF" => 317 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Ultrasound applications in the central nervous system for neuroanaesthesia and neurocritical care" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "314" "paginaFinal" => "320" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aplicaciones de la ultrasonografía en el sistema nervioso central para Neuroanestesia y cuidado neurocrítico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 993 "Ancho" => 2666 "Tamanyo" => 190551 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Visualization of the structures in a patient through the temporal bone window.</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Source: authors.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Lucas Ochoa-Pérez, Alejandro Cardozo-Ocampo" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Lucas" "apellidos" => "Ochoa-Pérez" ] 1 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Cardozo-Ocampo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0120334715000404" "doi" => "10.1016/j.rca.2015.03.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334715000404?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000346?idApp=UINPBA00004N" "url" => "/22562087/0000004300000004/v1_201510250024/S2256208715000346/v1_201510250024/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2256208715000358" "issn" => "22562087" "doi" => "10.1016/j.rcae.2015.04.007" "estado" => "S300" "fechaPublicacion" => "2015-10-01" "aid" => "217" "documento" => "article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Colomb Anestesiol. 2015;43:299-306" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1768 "formatos" => array:3 [ "EPUB" => 101 "HTML" => 1376 "PDF" => 291 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Health education</span>" "titulo" => "The FAST and extended FAST examinations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "299" "paginaFinal" => "306" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Examen FAST y FAST extendido" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1298 "Ancho" => 1950 "Tamanyo" => 209669 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">(a) Position of the high-frequency lineal transducer to evaluate pulmonary windows. (b) “Waves on the beach” in mode M indicates an absence of pneumothorax. (c) “Barcode” sign, as diagnosis for pneumothorax.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jorge Andrés Giraldo-Restrepo, Theider Jovany Serna-Jiménez" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Jorge Andrés" "apellidos" => "Giraldo-Restrepo" ] 1 => array:2 [ "nombre" => "Theider Jovany" "apellidos" => "Serna-Jiménez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0120334715000416" "doi" => "10.1016/j.rca.2015.03.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334715000416?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000358?idApp=UINPBA00004N" "url" => "/22562087/0000004300000004/v1_201510250024/S2256208715000358/v1_201510250024/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Health education</span>" "titulo" => "Airway management using ultrasound" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "307" "paginaFinal" => "313" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mario Andres Zamudio-Burbano, Fabian David Casas-Arroyave" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Mario Andres" "apellidos" => "Zamudio-Burbano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Fabian David" "apellidos" => "Casas-Arroyave" "email" => array:1 [ 0 => "fabiandavid68@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Resident of Anesthesiology and Resuscitation, Member of the Difficult Airway Team, Universidad de Antioquia, Medellín, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anesthesiologist, Hospital Universitario San Vicente Fundación, University Hospital San Vicente Foundation, Professor at the Anesthesiology Department, Universidad de Antioquia, Medellín, Colombia" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author at</span>: Calle 64 No. 51 D-154, Hospital Universitario San Vicente Fundación, Medellín, Colombia." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El uso del ultrasonido en el manejo de la vía aérea" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0045" "etiqueta" => "Fig. 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 493 "Ancho" => 1286 "Tamanyo" => 55275 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Longitudinal tracheal view – endotracheal tube (d); cricothyroid membrane (c); cricoid cartilage (b); tracheal rings (a). Observe the difference against the endotracheal tube image (e) in the tracheal axial view.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Airway management is one of the critical skills of the anesthesiologist. Close to 64% of the anesthesia-associated deaths are the result of airway management complications, both during induction and securing of the airway.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> Ultrasound is a portable, easy to use, noninvasive tool with high sensitivity rates than can be used in combination with other devises for proper perioperative airway management.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This review discusses the role of ultrasound as an additional complementary tool in the management of the airway in different situations, including the identification of structures, detection of esophageal intubation, positioning of the endotracheal tube, proper size selection of the conventional and double-lumen endotracheal tube, determination of adequate face mask or supraglottic device ventilation, difficult airway predictors, predictors of risk of postextubation stridor, and ultrasound-guided translaryngeal techniques, including translaryngeal blocks, retrograde intubation and percutaneous tracheostomy.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Preparation</span><p id="par0015" class="elsevierStylePara elsevierViewall">Adequate evaluation and ultrasound visualization of the airway requires the patient to be in a centered sniffing position.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> Since the structures to be visualized are superficial, most of the airway windows may be obtained using a 7.5-Mhz high-frequency lineal transducer. Remember to use a proper hydrosoluble gel for image optimization, eliminating the air interface, adjusting the equipment settings for superficial soft tissues, adjusting the depth to 3–4<span class="elsevierStyleHsp" style=""></span>cm and the focus 1<span class="elsevierStyleHsp" style=""></span>cm posterior to the structure to be visualized. If the target for visualization is the hyoid bone, an enhanced visualization may be achieved using the 5-Mhz convex transducer.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ultrasound identification of airway structures</span><p id="par0020" class="elsevierStylePara elsevierViewall">Air prevents the passage of ultrasound waves, generating hyper or hypo-echoic reverberation artifacts that hinder the visualization of deep structures but allows for easy identification of the airway since it is the only structure that produces comet tails, reverberations and acoustic shadowing.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The bone presents as a hyperechoic structure that produces an anechoic shadow; the main bone structure in the airway is the hyoid bone, but in over fifty percent of the patients it cannot be fully visualized.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The tracheal cartilages are hyperechoic, as well as the cricothyroid membrane and the vocal cords.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Furthermore, it is important to keep in mind that the mucosa/air interface looks hyperechoic, as for instance the interface below the cricothyroid membrane.</p><p id="par0040" class="elsevierStylePara elsevierViewall">There are two ultrasonography approaches for the airway: the axial or short axis and the longitudinal or long axis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<span class="elsevierStyleVsp" style="height:0.5px"></span><span class="elsevierStyleBold">Hyoid bone</span></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The identification of the hyoid bone may be from a transverse or longitudinal approach; it is a hyperechoic structure with a hypoechoic U-shape halo (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>); although there is no standard technique, successful cases have been reported of ultrasound-guided superior laryngeal nerve block at the horn of the hyoid bone.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleVsp" style="height:0.5px"></span><span class="elsevierStyleBold">Epiglottis</span></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">The epiglottis cross-section may be visualized with the high-frequency lineal transducer at the thyroid–hyoid space. It is characterized by a hypoechoic U-shape image preceded at its anterior margin by the pre-epiglottic space that is hyperechoic and relates posteriorly with the hyperechoic interface between the mucosa and the air<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<span class="elsevierStyleVsp" style="height:0.5px"></span><span class="elsevierStyleBold">Thyroid cartilage</span></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Is one of the best visualized structures described at the transverse axis as a hypoechoic structure with respect to the vocal cords, followed by an acoustic shadow corresponding to the airway (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>); on the sagittal plane, the thyroid–hyoid space and the acoustic shadow in the hyoid bone can be evaluated (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7,8</span></a> At this level, the vocal cords can be seen as hypoechoic structures. Pathological conditions such as the unilateral paralysis of the vocal cords may be identified at this level, when the patient is asked to emit a sound to see the vibration of the vocal cords – adduction and abduction of the vocal cords (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<span class="elsevierStyleVsp" style="height:0.5px"></span><span class="elsevierStyleBold">Cricoid cartilage</span></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">The cricoid cartilage is a hypoechoic, inverted U structure inferior to the thyroid cartilage; the posterior acoustic shadow corresponds to the airway <a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>. The window is more important to take transverse measurements and to select the size of the endotracheal tube.<span class="elsevierStyleVsp" style="height:0.5px"></span><span class="elsevierStyleBold">Cricothyroid membrane</span></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">A hypoechoic structure between the thyroid and the cricoid cartilages can be observed through a longitudinal section along the larynx (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). Using color Doppler the blood vessels over the laryngeal and tracheal structures can be identified, to avoid the risk of puncturing the vessels when a trans laryngeal puncture is made.<span class="elsevierStyleVsp" style="height:0.5px"></span><span class="elsevierStyleBold">Tracheal rings</span></p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Semicircular hypoechoic structures can be seen at the longitudinal axis (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>). The puncture sites are located between the tracheal spaces for percutaneous tracheostomy.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Verification of endotracheal tube placement</span><p id="par0075" class="elsevierStylePara elsevierViewall">Several ultrasound techniques have been reported to detect proper intubation. These techniques may be direct with transverse or longitudinal visualization through the neck, or indirectly visualizing the pulmonary ventilation and the movement of the diaphragm; these may be assessed either at the time of intubation or after placing the endotracheal tube.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9–13</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In order to obtain a proper transverse neck window for the detection of endotracheal intubation, the lineal transducer is used at the level of the cricoid cartilage, making sure that the esophagus is visualized. The successful endotracheal intubation may be confirmed in real time with the artifacts generated when the tube is introduced inside the trachea; if intubation fails, a new circular structure can be seen with artifacts generated by the presence of the tube inside the esophagus.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> This technique is similar with a longitudinal window, parallel to the left side of the trachea to visualize the esophagus; however, it is technically easier with a transverse window. In a tracheal intubation the movements of the tracheal rings are made visible and occasionally the endotracheal tube; if the intubation fails, a new air-filled structure deeper than the trachea will be identified (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>). The sensitivity of this strategy to detect esophageal intubation in real time with the intubation maneuver is 97 a 100%<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9,14</span></a> after just 5<span class="elsevierStyleHsp" style=""></span>min of training<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a>; furthermore, there is no need to ventilate and this represents one additional advantage of ultrasound versus the classical measures for checking tracheal intubation, particularly in patients with low cardiac output or cardiac arrest.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The indirect tracheal intubation measures include the use of the lineal or curved transducer for checking ventilation throughout the pulmonary fields, visualizing the pleural shift between two ribs, with up to 100% rates to confirm both the tracheal intubation and the proper face mask ventilation or any other supraglottic device in patients with apnea.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">16</span></a> In addition to the confirmation of the bi-pulmonary ventilation, it is also possible to check the tracheal placement of the endotracheal tube instead of the principal bronchi and this approach has been successful in ICU pediatric patients to reduce the amount of X-ray radiation. Another option is the use of the curved transducer at the right and left costal-phrenic angles to visualize the diaphragm moving consistently with the mechanical ventilation to enable proper identification of the tracheal intubation in patients with pneumothorax.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Measurement of the subglottic diameter</span><p id="par0090" class="elsevierStylePara elsevierViewall">Numerous successful cases have been reported since 2007 measuring the transverse subglottic diameter at the level of the cricoid cartilage for selecting the right external diameter of the endotracheal tube. This tool is particularly useful in pediatric >12 month-old patients when performing histopathological analyses.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">17–19</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Difficult airway predictors</span><p id="par0095" class="elsevierStylePara elsevierViewall">There is growing academic interest in the use of ultrasound to identify the difficult airway predictors; though still under discussion, there are increasing numbers of papers on the topic, particularly to measure the pre-tracheal fat in obese patients. A transverse window at the level of the vocal cords is used for proper measurement, and then the anteroposterior diameter is measured at the midline from the skin of the trachea to 15<span class="elsevierStyleHsp" style=""></span>mm of the right and left sides. If the sum of these three measurements exceeds 28<span class="elsevierStyleHsp" style=""></span>mm in a patient with a neck circumference larger than 50<span class="elsevierStyleHsp" style=""></span>cm and a BMI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>35<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>, is predictive of a difficult laryngoscopy – Cormark visualization 3 or 4, in 70% of the cases (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>). According to Ezri et al.,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">20</span></a> all patients with difficult laryngoscopy were positively correlated with increased pre tracheal fat at the level of the vocal cords.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">20,21</span></a></p><elsevierMultimedia ident="fig0040"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Ultrasound guided trans laryngeal techniques</span><p id="par0100" class="elsevierStylePara elsevierViewall">Though only few cases have been reported, there is a growing use of ultrasonography to guide trans laryngeal blocks to theoretically prevent airway bruising by selecting an avascular site for the puncture. Similarly, the use of ultrasound has also been described to guide the puncture for successful retrograde intubation and percutaneous tracheostomy, in patients in whom the identification of the structures is difficult such as in obese patients, patients with masses that distort the airway or trauma. In these cases, ultrasound helps with the correct identification of the airway and the cricothyroid membrane, and facilitates an emergency trans laryngeal approach if needed.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">5,22–25</span></a> Ultrasound is also helpful for the safe removal of the endotracheal tube in ICU patients that are intubated and require percutaneous tracheostomy (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>). However, there is no evidence of the superiority of ultrasound versus fibroscopy for guiding percutaneous tracheostomy.</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Predicting postextubation stridor</span><p id="par0105" class="elsevierStylePara elsevierViewall">The use of ultrasonography may be a tool to identify patients at risk of stridor following extubation. In this case, the short axis in the thyroid window is evaluated (<a class="elsevierStyleCrossRef" href="#fig0050">Fig. 10</a>), measuring the air column in the laterolateral diameter; a measurement less than 4.5<span class="elsevierStyleHsp" style=""></span>mm is considered a risk factor for stridor as compared to the normal 6.4<span class="elsevierStyleHsp" style=""></span>mm value.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></p><elsevierMultimedia ident="fig0050"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusion</span><p id="par0110" class="elsevierStylePara elsevierViewall">Perioperative ultrasound is a useful, easy to use, safe and non-invasive tool, with high sensitivity and specificity that does not require ionizing radiation and hence allows for improved performance, assisting in decision-making for the management of surgical patients, particularly the critically ill patient. Although its use in the airway is just starting to grow, there are clinical trials available showing high effectiveness, particularly in the context of ventilation, endotracheal intubation verification, endotracheal tube placement, and selection of the tube external diameter. However, further research is needed to determine whether the use of this technique may have any real impact on the outcomes of a mismanaged difficult airway.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors did not receive sponsorship to undertake this article.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conflicts of interests</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:16 [ 0 => array:3 [ "identificador" => "xres573658" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec590587" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres573657" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec590588" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Preparation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Ultrasound identification of airway structures" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Verification of endotracheal tube placement" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Measurement of the subglottic diameter" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Difficult airway predictors" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Ultrasound guided trans laryngeal techniques" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Predicting postextubation stridor" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusion" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 14 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interests" ] 15 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-11-01" "fechaAceptado" => "2015-03-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec590587" "palabras" => array:5 [ 0 => "Ultrasonography" 1 => "Airway management" 2 => "Intubation" 3 => "Epiglottis" 4 => "Anesthesia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec590588" "palabras" => array:5 [ 0 => "Ultrasonografía" 1 => "Manejo de la vía aérea" 2 => "Intubación" 3 => "Epiglotis" 4 => "Anestesia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ultrasonography as a diagnostic and therapeutic tool has greatly impacted the anesthesiologist's routine in multiple practical applications. However, only recently there have been some reports published in the literature on the use of ultrasonography for the management of the airway in the surgical and ICU patients. Being a portable, easy to use, non-invasive tool that does not require any ionizing energy, ultrasonography becomes highly attractive when the anesthesiologist faces practical issues in a difficult airway. The purpose of this review was precisely to show the potential uses of ultrasonography for difficult airway management, from the literature perspective.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">There is enough trials-based evidence so far to recommend the use of ultrasonography for the following situations: identification of anatomical airway structures, static detection of a failed or esophageal intubation, dynamic airway measurements, and size determination of endotracheal tubes; identification of predictors of a difficult airway in patients with challenging necks, and trans-tracheal techniques to secure the airway.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nevertheless, further studies with strong methodological quality are required to show the potential of ultrasonography to impact the difficult airway management and the morbidity and mortality associated with this condition.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La ecografía como herramienta diagnóstica y terapéutica ha tenido un gran impacto en el quehacer rutinario del anestesiólogo en múltiples áreas de aplicación práctica. Sin embargo, es hasta hace poco en donde han aparecido en la literatura reportes de su uso en situaciones que involucra el manejo de la vía área del paciente en cirugía y unidades de cuidados intensivos. Al ser esta una herramienta portable, fácil de usar, no invasiva y sin necesidad de energía ionizante, la hace altamente atractiva al momento de resolver preguntas prácticas del anestesiólogo que se ve enfrentado a una vía área difícil. Justamente el objetivo de esta revisión fue mostrar desde la literatura cuales son los potenciales usos de los ecografía en el manejo de la vía área.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Hasta el momento los estudios muestran suficientes elementos para recomendar su uso en los siguientes situaciones: identificación de estructuras anatómicas en la vía área; detección estática de intubación fallida o esofágica; mediciones dinámicas de la vía área y determinación del tamaño de tubos endotraqueales; predictores de vía área difícil en pacientes con cuello desfavorable; y técnicas transtraqueales para aseguramiento de la vía área.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A pesar de ello, aún se requieren mayores estudios con suficiente calidad metodológica en donde se demuestre que el uso de la ecografía si puede llegar a impactar en el manejo de la vía área difícil y en la morbimortalidad generada por esta entidad.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Zamudio-Burbano MA, Casas-Arroyabe FD. El uso del ultrasonido en el manejo de la vía aérea. Rev Colomb Anestesiol. 2015;43:307–313.</p>" ] ] "multimedia" => array:10 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 425 "Ancho" => 1299 "Tamanyo" => 71961 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Axial or short-axis approach (A) and longitudinal or long axis approach (B).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 881 "Ancho" => 975 "Tamanyo" => 84793 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Cross-section of the floor of the mouth. (A) Hyperechoic hyoid bone with posterior acoustic shadow.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 859 "Ancho" => 950 "Tamanyo" => 62722 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cross-section of the thyroid–hyoid space.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 575 "Ancho" => 1300 "Tamanyo" => 84735 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Cross-section of the glottis. (A) Open glottis, a: thyroid cartilage; b: vocal cords. (B) Closed glottis.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 576 "Ancho" => 1299 "Tamanyo" => 62411 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cross-section of the subglottis. a: horseshoe shape cricoid cartilage. Line b: measurement of the transverse diameter of the airway from the inner margin of the cricoid to the contralateral inner margin.</p>" ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 890 "Ancho" => 975 "Tamanyo" => 71409 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Longitudinal axis of the airway at the level of the pharynx. (a) Tracheal cartilages; (b) cricoid cartilages; (c) cricothyroid membrane.</p>" ] ] 6 => array:8 [ "identificador" => "fig0035" "etiqueta" => "Fig. 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 744 "Ancho" => 970 "Tamanyo" => 82267 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The axial view depicts two circular structures with air artifacts, the trachea (b) and the esophagus (a), consistent with esophageal intubation. Part of the thyroid gland (c) and the left carotid artery (d) are also visible.</p>" ] ] 7 => array:8 [ "identificador" => "fig0040" "etiqueta" => "Fig. 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 916 "Ancho" => 975 "Tamanyo" => 75916 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">The soft tissue measurement is done through the axial thyroid window, averaging the distance from the skin to the airway along the midline (a), and 15<span class="elsevierStyleHsp" style=""></span>mm to the left and right sides (b).</p>" ] ] 8 => array:8 [ "identificador" => "fig0045" "etiqueta" => "Fig. 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 493 "Ancho" => 1286 "Tamanyo" => 55275 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Longitudinal tracheal view – endotracheal tube (d); cricothyroid membrane (c); cricoid cartilage (b); tracheal rings (a). Observe the difference against the endotracheal tube image (e) in the tracheal axial view.</p>" ] ] 9 => array:8 [ "identificador" => "fig0050" "etiqueta" => "Fig. 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: Authors." "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 622 "Ancho" => 1299 "Tamanyo" => 67809 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The air column (hypoechoic) can be seen in the axial window of the thyroid cartilage.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anesthesia-related cardiac arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.J. Ellis" 1 => "M.C. Newland" 2 => "J.A. Simonson" 3 => "K.R. Peters" 4 => "D.J. Romberger" 5 => "D.W. Mercer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0000000000000153" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2014" "volumen" => "120" "paginaInicial" => "829" "paginaFinal" => "838" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24496124" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0140" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound imaging of the airway" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Prasad" 1 => "M. Singh" 2 => "V.W. Chan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12630-009-9162-2" "Revista" => array:6 [ "tituloSerie" => "Can J Anaesth" "fecha" => "2009" "volumen" => "56" "paginaInicial" => "868" "paginaFinal" => "869" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19711145" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0145" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound for the anesthesiologists: present and future" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.S. Terkawi" 1 => "D. Karakitsos" 2 => "M. Elbarbary" 3 => "M. Blaivas" 4 => "M.E. Durieux" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Sci World J" "fecha" => "2013" "volumen" => "2013" "paginaInicial" => "683" "paginaFinal" => "685" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0150" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.S. Kristensen" 1 => "W.H. Teoh" 2 => "O. Graumann" 3 => "C.B. Laursen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13244-014-0309-5" "Revista" => array:6 [ "tituloSerie" => "Insights Imaging" "fecha" => "2014" "volumen" => "5" "paginaInicial" => "253" "paginaFinal" => "279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24519789" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0155" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Applications of ultrasonography in ENT: airway assessment and nerve blockade" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.S. Green" 1 => "B.C. Tsui" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anclin.2010.07.012" "Revista" => array:6 [ "tituloSerie" => "Anesthesiol Clin" "fecha" => "2010" "volumen" => "28" "paginaInicial" => "541" "paginaFinal" => "553" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20850084" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0160" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anatomy and assessment of the pediatric airway" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Adewale" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1460-9592.2009.03012.x" "Revista" => array:7 [ "tituloSerie" => "Paediatr Anaesth" "fecha" => "2009" "volumen" => "19" "numero" => "Suppl. 1" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19572839" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0165" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Airway sonography in live models and cadavers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B. Tsui" 1 => "V. Ip" 2 => "A. Walji" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7863/ultra.32.6.1049" "Revista" => array:6 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "2013" "volumen" => "32" "paginaInicial" => "1049" "paginaFinal" => "1058" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23716527" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0170" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A method for ultrasonographic visualization and injection of the superior laryngeal nerve: volunteer study and cadaver simulation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Kaur" 1 => "R. Tang" 2 => "A. Sawka" 3 => "C. Krebs" 4 => "H. Vaghadia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0b013e318265f75d" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2012" "volumen" => "115" "paginaInicial" => "1242" "paginaFinal" => "1245" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22822197" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0175" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound associated to capnography to verify correct endotracheal tube positioning in prehospital" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P.M. Brun" 1 => "J. Bessereau" 2 => "N. Cazes" 3 => "E. Querellou" 4 => "H. Chenaitia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "2012" "volumen" => "30" "paginaInicial" => "2080-e5" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0180" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of bedside ultrasonography for endotracheal tube placement in pediatric patients: a feasibility study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Galicinao" 1 => "A.J. Bush" 2 => "S.A. Godambe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2006-2959" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2007" "volumen" => "120" "paginaInicial" => "1297" "paginaFinal" => "1303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18055679" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0185" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective comparison of diaphragmatic ultrasound and chest radiography to determine endotracheal tube position in a pediatric emergency department" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.T. Kerrey" 1 => "G.L. Geis" 2 => "A.M. Quinn" 3 => "R.W. Hornung" 4 => "R.M. Ruddy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2008-2828" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "2009" "volumen" => "123" "paginaInicial" => "e1039" "paginaFinal" => "e1044" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19414520" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0190" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Confirmation of endotracheal tube position: a narrative review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Rudraraju" 1 => "L.A. Eisen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0885066609340501" "Revista" => array:6 [ "tituloSerie" => "J Intensive Care Med" "fecha" => "2009" "volumen" => "24" "paginaInicial" => "283" "paginaFinal" => "292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19654121" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0195" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of sonography for rapid identification of esophageal and tracheal intubations in adult patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Muslu" 1 => "H. Sert" 2 => "A. Kaya" 3 => "R.I. Demircioglu" 4 => "M. Gözdemir" 5 => "B. Usta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Ultrasound Med" "fecha" => "2011" "volumen" => "30" "paginaInicial" => "671" "paginaFinal" => "676" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21527615" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0200" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.C. Chou" 1 => "K.M. Chong" 2 => "S.S. Sim" 3 => "M.H. Ma" 4 => "S.H. Liu" 5 => "N.C. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2013.06.018" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2013" "volumen" => "84" "paginaInicial" => "1708" "paginaFinal" => "1712" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23851048" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0205" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The sensitivity and specificity of transcricothyroid ultrasonography to confirm endotracheal tube placement in a cadaver model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Ma" 1 => "D.P. Davis" 2 => "J. Schmitt" 3 => "G.M. Vilke" 4 => "T.C. Chan" 5 => "S.R. Hayden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jemermed.2006.08.023" "Revista" => array:6 [ "tituloSerie" => "J Emerg Med" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "405" "paginaFinal" => "407" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17499695" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0210" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direct ultrasound methods: a confirmatory technique for proper endotracheal intubation in the emergency department" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Abbasi" 1 => "D. Farsi" 2 => "M.A. Zare" 3 => "M. Hajimohammadi" 4 => "M. Rezai" 5 => "P. Hafezimoghadam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MEJ.0000000000000108" "Revista" => array:6 [ "tituloSerie" => "Eur J Emerg Med" "fecha" => "2014" "volumen" => "22" "paginaInicial" => "10" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24441884" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0215" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound measurement of subglottic diameter and an empirical formula for proper endotracheal tube fitting in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E.J. Kim" 1 => "S.Y. Kim" 2 => "W.O. Kim" 3 => "H. Kim" 4 => "H.K. Kil" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/aas.12167" "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "2013" "volumen" => "57" "paginaInicial" => "1124" "paginaFinal" => "1130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23909603" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0220" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of ultrasound compared to age-related formulas for uncuffed endotracheal intubation in a pediatric population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Schramm" 1 => "J. Knop" 2 => "K. Jensen" 3 => "K. Plaschke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1460-9592.2012.03889.x" "Revista" => array:6 [ "tituloSerie" => "Paediatr Anaesth" "fecha" => "2012" "volumen" => "22" "paginaInicial" => "781" "paginaFinal" => "786" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22612446" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0225" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of pediatric endotracheal tube size by ultrasonography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Shibasaki" 1 => "Y. Nakajima" 2 => "S. Ishii" 3 => "F. Shimizu" 4 => "N. Shime" 5 => "D.I. Sessler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e3181ef6757" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2010" "volumen" => "113" "paginaInicial" => "819" "paginaFinal" => "824" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20808208" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0230" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Ezri" 1 => "G. Gewürtz" 2 => "D.I. Sessler" 3 => "B. Medalion" 4 => "P. Szmuk" 5 => "C. Hagberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "2003" "volumen" => "58" "paginaInicial" => "1111" "paginaFinal" => "1114" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14616599" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0235" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is ultrasonic investigation of transverse tracheal air shadow diameter reasonable for evaluation of difficult airway in pregnant women: a prospective comparative study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Turkay Aydogmus" 1 => "K. Erkalp" 2 => "S. Nadir Sinikoglu" 3 => "T.A. Usta" 4 => "O. Ulger" 5 => "G.A. Alagol" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12669/pjms.301.3972" "Revista" => array:6 [ "tituloSerie" => "Pak J Med Sci" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "91" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24639838" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0240" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retrograde tracheal intubation for bleeding and fragmenting airway tumours" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.R. Ball" 1 => "M. Stallard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.12571" "Revista" => array:5 [ "tituloSerie" => "Anaesthesia" "fecha" => "2014" "volumen" => "69" "paginaInicial" => "182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24443858" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0245" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasound-guided retrograde intubation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Vieira" 1 => "N. Lages" 2 => "J. Dias" 3 => "L. Maria" 4 => "C. Correia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/anae.12430" "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "2013" "volumen" => "68" "paginaInicial" => "1075" "paginaFinal" => "1076" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24047297" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0250" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tracheostomy in critically ill patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Mallick" 1 => "A.R. Bodenham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/EJA.0b013e32833b1ba0" "Revista" => array:6 [ "tituloSerie" => "Eur J Anaesthesiol" "fecha" => "2010" "volumen" => "27" "paginaInicial" => "676" "paginaFinal" => "682" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20523214" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0255" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accuracy of ultrasound-guided marking of the cricothyroid membrane before simulated failed intubation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Mallin" 1 => "K. Curtis" 2 => "M. Dawson" 3 => "P. Ockerse" 4 => "M. Ahern" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Emerg Med" "fecha" => "2014" "volumen" => "32" "paginaInicial" => "61" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24475485" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0260" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.W. Ding" 1 => "H.C. Wang" 2 => "H.D. Wu" 3 => "C.J. Chang" 4 => "P.C. Yang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.06.00029605" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "384" "paginaFinal" => "389" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16452597" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22562087/0000004300000004/v1_201510250024/S2256208715000334/v1_201510250024/en/main.assets" "Apartado" => array:4 [ "identificador" => "45200" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Health education" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22562087/0000004300000004/v1_201510250024/S2256208715000334/v1_201510250024/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2256208715000334?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 5 | 19 |
| 2024 October | 79 | 11 | 90 |
| 2024 September | 102 | 18 | 120 |
| 2024 August | 94 | 14 | 108 |
| 2024 July | 110 | 12 | 122 |
| 2024 June | 65 | 8 | 73 |
| 2024 May | 87 | 9 | 96 |
| 2024 April | 131 | 17 | 148 |
| 2024 March | 98 | 12 | 110 |
| 2024 February | 102 | 28 | 130 |
| 2024 January | 142 | 23 | 165 |
| 2023 December | 107 | 25 | 132 |
| 2023 November | 118 | 28 | 146 |
| 2023 October | 136 | 31 | 167 |
| 2023 September | 71 | 14 | 85 |
| 2023 August | 99 | 15 | 114 |
| 2023 July | 107 | 14 | 121 |
| 2023 June | 117 | 33 | 150 |
| 2023 May | 158 | 26 | 184 |
| 2023 April | 132 | 14 | 146 |
| 2023 March | 130 | 32 | 162 |
| 2023 February | 121 | 24 | 145 |
| 2023 January | 98 | 13 | 111 |
| 2022 December | 67 | 13 | 80 |
| 2022 November | 75 | 28 | 103 |
| 2022 October | 76 | 29 | 105 |
| 2022 September | 95 | 36 | 131 |
| 2022 August | 129 | 19 | 148 |
| 2022 July | 63 | 32 | 95 |
| 2022 June | 73 | 19 | 92 |
| 2022 May | 100 | 45 | 145 |
| 2022 April | 78 | 21 | 99 |
| 2022 March | 92 | 31 | 123 |
| 2022 February | 107 | 20 | 127 |
| 2022 January | 124 | 24 | 148 |
| 2021 December | 104 | 32 | 136 |
| 2021 November | 88 | 38 | 126 |
| 2021 October | 127 | 23 | 150 |
| 2021 September | 92 | 17 | 109 |
| 2021 August | 112 | 20 | 132 |
| 2021 July | 60 | 41 | 101 |
| 2021 June | 50 | 7 | 57 |
| 2021 May | 72 | 15 | 87 |
| 2021 April | 228 | 58 | 286 |
| 2021 March | 141 | 26 | 167 |
| 2021 February | 113 | 33 | 146 |
| 2021 January | 123 | 23 | 146 |
| 2020 December | 262 | 86 | 348 |
| 2020 November | 70 | 8 | 78 |
| 2020 October | 51 | 14 | 65 |
| 2020 September | 48 | 13 | 61 |
| 2020 August | 42 | 11 | 53 |
| 2020 July | 46 | 10 | 56 |
| 2020 June | 35 | 7 | 42 |
| 2020 May | 29 | 11 | 40 |
| 2020 April | 48 | 5 | 53 |
| 2020 March | 33 | 9 | 42 |
| 2020 February | 56 | 14 | 70 |
| 2020 January | 40 | 6 | 46 |
| 2019 December | 44 | 11 | 55 |
| 2019 November | 29 | 4 | 33 |
| 2019 October | 20 | 4 | 24 |
| 2019 September | 17 | 3 | 20 |
| 2019 August | 5 | 3 | 8 |
| 2019 July | 2 | 3 | 5 |
| 2019 June | 3 | 2 | 5 |
| 2019 May | 0 | 7 | 7 |
| 2019 April | 1 | 0 | 1 |
| 2018 December | 1 | 0 | 1 |
| 2018 September | 1 | 0 | 1 |
| 2018 June | 11 | 4 | 15 |
| 2018 May | 51 | 5 | 56 |
| 2018 April | 41 | 8 | 49 |
| 2018 March | 42 | 7 | 49 |
| 2018 February | 32 | 8 | 40 |
| 2018 January | 48 | 3 | 51 |
| 2017 December | 40 | 5 | 45 |
| 2017 November | 27 | 6 | 33 |
| 2017 October | 49 | 12 | 61 |
| 2017 September | 47 | 7 | 54 |
| 2017 August | 28 | 6 | 34 |
| 2017 July | 39 | 7 | 46 |
| 2017 June | 44 | 20 | 64 |
| 2017 May | 60 | 6 | 66 |
| 2017 April | 63 | 14 | 77 |
| 2017 March | 48 | 10 | 58 |
| 2017 February | 86 | 5 | 91 |
| 2017 January | 36 | 12 | 48 |
| 2016 December | 51 | 8 | 59 |
| 2016 November | 45 | 9 | 54 |
| 2016 October | 49 | 12 | 61 |
| 2016 September | 83 | 8 | 91 |
| 2016 August | 61 | 23 | 84 |
| 2016 July | 41 | 36 | 77 |
| 2016 June | 1 | 0 | 1 |
| 2016 May | 2 | 0 | 2 |
| 2016 April | 2 | 0 | 2 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 7 | 37 | 44 |
| 2015 December | 16 | 16 | 32 |
| 2015 November | 39 | 20 | 59 |
| 2015 October | 2 | 1 | 3 |
Show all