Strategies to improve first attempt success at intubation in critically ill patients

• Published in: British journal of anaesthesia : BJA Vol. 117; no. suppl_1; pp. i60 - i68
• Main Authors: Natt, B.S., Malo, J., Hypes, C.D., Sakles, J.C., Mosier, J.M.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2016; Oxford University Press
• Subjects: airway management; Airway Management - adverse effects; Airway Management - methods; Airway Management - standards; Anesthesia, General - methods; Clinical Competence; critical care; Critical Care - methods; Critical Illness - therapy; Emergencies; emergency department; emergency medicine; Humans; Hypotension - etiology; Hypotension - prevention & control; intensive care; intubation; Intubation, Intratracheal - adverse effects; Intubation, Intratracheal - methods; Intubation, Intratracheal - standards; laryngoscopy; Oxygen Inhalation Therapy - methods; prehospital; intensive care; prehospital; emergency medicine; airway management; critical care; laryngoscopy; intubation; emergency department
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aew061

Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient's tolerance for repeated or prolonged attempts at laryngoscopy and, as a result, hypoxaemia and haemodynamic deterioration are common complications. Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the ‘difficult airway’ in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.