Difficult Airway Society guidelines on the airway management of critically ill patients. A reply

In critically ill patients in Intensive Care Unit (ICU), patency of airway and managementof difficult airway are of utmost importance. The incidence of difficult intubation maybe 10% to 22% depending on the various factors in patient as well as availability ofequipment facilities. As compared to the regular surgery in operation theatre, themanagement of airway in critically ill patients is considerably different and morechallenging. The physiological reserve and co-morbidities are more common in criticallyill patients. In ICU, recent techniques of airway management must be considered andpracticed, such as videolaryngoscope (VLS), fiberoptic bronchoscope and supraglotticdevices. The success for airway management would be greater if airway expert, therequired devices and an adequate protocol are available. The outcome of managingairway would be enhanced if best use of available airway devices in a particular hospitalsetup since every instrument may not be available. The standard guidelines for difficultairway and the protocol of individual hospital may reduce the complications; hencemust be followed. The availability of difficult airway cart and capnograph is a must. Theindications and timing of surgical airway must be clear to the airway team. The Trainingcourses for the staff in ICU should be held regularly to apprise them of advancementin airway management. The best use of available airway equipment should be made incritically ill patients. At least, one airway expert must be accessible in ICU at any giventime. Received: 12 Sep 2018Reviewed: 5 Oct 2018Accepted: 10 Oct 2018 Citation: Malhotra SK, Gandhi K. Airway management in critically sick in intensive care. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S21-S28

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Emergency Surgical Airways Following Activation of a Difficult Airway Management Team in Hospitalized Critically Ill Patients: A Case Series

Journal of Intensive Care Medicine ◽

10.1177/0885066616680594 ◽

2016 ◽

Vol 33 (9) ◽

pp. 517-526 ◽

Cited By ~ 4

Author(s):

Joseph M. Darby ◽

Gregory Halenda ◽

Courtney Chou ◽

Joseph J. Quinlan ◽

Louis H. Alarcon ◽

...

Keyword(s):

Airway Management ◽

Difficult Airway ◽

Critically Ill ◽

Critically Ill Patients ◽

Case Series ◽

Management Team ◽

Team Approach ◽

High Morbidity ◽

Difficult Airway Management ◽

Surgical Airway

Introduction: An emergency surgical airway (ESA) is widely recommended for securing the airway in critically ill patients who cannot be intubated or ventilated. Little is known of the frequency, clinical circumstances, management methods, and outcomes of hospitalized critically ill patients in whom ESA is performed outside the emergency department or operating room environments. Methods: We retrospectively reviewed all adult patients undergoing ESA in our intensive care units (ICUs) and other hospital units from 2008 to 2012 following activation of our difficult airway management team (DAMT). Results: Of 207 DAMT activations for native airway events, 22 (10.6%) events culminated in an ESA, with 59% of these events occurring in ICUs with the remainder outside the ICU in the context of rapid response team activations. Of patients undergoing ESA, 77% were male, 63% were obese, and 41% had a history of a difficult airway (DA). Failed planned or unplanned extubations preceded 61% of all ESA events in the ICUs, while bleeding from the upper or lower respiratory tract led to ESA in 44% of events occurring outside the ICU. Emergency surgical airway was the primary method of airway control in 3 (14%) patients, with the remainder of ESAs performed following failed attempts to intubate. Complications occurred in 68% of all ESAs and included bleeding (50%), multiple cannulation attempts (36%), and cardiopulmonary arrest (27%). Overall hospital mortality for patients undergoing ESA was 59%, with 38% of deaths occurring at the time of the airway event. Conclusion: An ESA is required in approximately 10% of DA events in critically ill patients and is associated with high morbidity and mortality. Efforts directed at early identification of patients with a difficult or challenging airway combined with a multidisciplinary team approach to management may reduce the overall frequency of ESA and associated complications.

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Guía de manejo de la vía aérea en el paciente crítico adulto.

Revista Electrónica AnestesiaR ◽

10.30445/rear.v11i9.788 ◽

2019 ◽

Vol 11 (9) ◽

pp. 4

Author(s):

Jose Ángel Monsalve Naharro ◽

Pedro Manuel Canales Lara ◽

José Vicente Catalá Ripoll ◽

Beatriz Moreno Flores

Keyword(s):

Tracheal Intubation ◽

Airway Management ◽

Difficult Airway ◽

Critically Ill ◽

Critically Ill Patients ◽

Comprehensive Strategy ◽

Critically Ill Adults ◽

Ill Adults

Se trata de una guía de práctica clínica de la Difficult Airway Society (DAS) británica que expone una estrategia para optimizar el manejo de la VA durante la intubación orotraqueal en el paciente crítico adulto, en cualquier localización hospitalaria. Abstract Guidelines for the management of airway in critically ill adults. These guidelines of the Difficult Airway Society describe a comprehensive strategy to optimize airway management and tracheal intubation in critically ill patients, in all hospital locations.

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Airway Management in Critically Ill Patients

CHEST Journal ◽

10.1378/chest.07-0624 ◽

2007 ◽

Vol 132 (5) ◽

pp. 1714

Author(s):

Ali Al-Khafaji ◽

Su Min Cho

Keyword(s):

Airway Management ◽

Critically Ill ◽

Critically Ill Patients

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Use of stylet and airway management procedure in critically ill patients. Author's reply

Intensive Care Medicine ◽

10.1007/s00134-021-06518-8 ◽

2021 ◽

Author(s):

Samir Jaber ◽

Audrey De Jong

Keyword(s):

Airway Management ◽

Critically Ill ◽

Critically Ill Patients ◽

Management Procedure

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Airway Management

10.2310/7ccsp.8360 ◽

2019 ◽

Author(s):

James M. Dargin ◽

Lillian L. Emlet

Keyword(s):

Airway Management ◽

Critically Ill ◽

Endotracheal Intubation ◽

Critically Ill Patients ◽

Supraglottic Airway ◽

Positive Pressure ◽

Emergency Airway ◽

Rapid Sequence ◽

Bag Mask Ventilation ◽

Upper Gastrointestinal

Endotracheal intubation is a commonly performed procedure in the intensive care unit (ICU). Active upper gastrointestinal bleeding, emesis in the airway, and the presence of a cervical collar are just a few examples of conditions encountered in critically ill patients that can make endotracheal intubation difficult. Furthermore, critically ill patients usually require intubation because they have exhausted their physiologic reserve and can deteriorate rapidly due to vasodilation from induction medications, reduction in preload from positive pressure ventilation, hypercapnia and acidosis during periods of apnea, hypoxia from failed attempts at intubation, and an increase in intracranial pressure during laryngoscopy attempts. Up to one third of patients undergoing emergency airway management will develop serious complications, including hypoxemia, hypotension, aspiration, or cardiac arrest. Careful planning, provision of the appropriate equipment and personnel, and an understanding of an individual patient’s physiologic derangements can help to prevent complications during intubation. This review 13 figures, 4 tables, and 27 references. Keywords: airway, intubation, endotracheal, rapid sequence, pre-oxygenation, bag-mask ventilation, laryngoscopy, cricothyrotomy, supraglottic airway

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