Standard intubation in the ICU

Due to secretions, blood, or oedema in the patients’ airways, compromised pulmonary and haemodynamic, as well as limited access to the patients’ head the standard intubation in the ICU is an overall challenging procedure. Planning, preparation, and straight forwarded strategies are therefore mandatory. As a basic measure, sufficient pre-oxygenation should always be performed. Repetitive intubation attempts significantly worsen patients’ outcomes and need to be avoided. As adequate anaesthesia, including full neuromuscular blockade, can facilitate orotracheal intubation, this should be part of the routine. Apnoeic oxygenation during laryngoscopy by oxygen application via a nasal probe seems to be beneficial to prolong time to desaturation. Despite the fact that nowadays orotracheal intubation in the ICU is probably performed using mainly direct laryngoscopy, video laryngoscopes will possibly have increasing value on the ICU. Extraglottic airway devices represent useful tools to ventilate and oxygenate the patients’ lungs in case of an unexpected failed intubation attempt also on the ICU. In order to confirm adequate ventilation, capnography represents the standard of care and has to be a matter of course whenever a patient needs ventilator support on the ICU.