Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec;60(12):922-930.
doi: 10.4103/0019-5049.195485.

The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit

Sheila Nainan Myatra  1 , Syed Moied Ahmed  2 , Pankaj Kundra  3 , Rakesh Garg  4 , Venkateswaran Ramkumar  5 , Apeksh Patwa  6 , Amit Shah  6 , Ubaradka S Raveendra  7 , Sumalatha Radhakrishna Shetty  7 , Jeson Rajan Doctor  1 , Dilip K Pawar  8 , Singaravelu Ramesh  9 , Sabyasachi Das  10 , Jigeeshu Vasishtha Divatia  1
Affiliations

The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit

Sheila Nainan Myatra et al. Indian J Anaesth. 2016 Dec.

Abstract

Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often life-saving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with a suboptimal evaluation of the airway and limited oxygen reserves despite adequate pre-oxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxaemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. Non-invasive positive pressure ventilation during pre-oxygenation improves oxygen stores in patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnoea before the occurrence of hypoxaemia. High-flow nasal cannula oxygenation at 60-70 L/min may also increase safety during TI in critically ill patients. Stable haemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

Keywords: Complications; emergency department; intensive care; intubation bundle; ketamine; non-invasive positive pressure ventilation; tracheal intubation.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
All India Difficult Airway Association 2016 algorithm for the management of tracheal intubation in the Intensive Care Unit
See this image and copyright information in PMC

References

    1. Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology. 1995;82:367–76. - PubMed
    1. Jaber S, Amraoui J, Lefrant JY, Arich C, Cohendy R, Landreau L, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the Intensive Care Unit: A prospective, multiple-center study. Crit Care Med. 2006;34:2355–61. - PubMed
    1. Griesdale DE, Bosma TL, Kurth T, Isac G, Chittock DR. Complications of endotracheal intubation in the critically ill. Intensive Care Med. 2008;34:1835–42. - PubMed
    1. Jabre P, Avenel A, Combes X, Kulstad E, Mazariegos I, Bertrand L, et al. Morbidity related to emergency endotracheal intubation - A substudy of the KETAmine SEDation trial. Resuscitation. 2011;82:517–22. - PubMed
    1. Breckwoldt J, Klemstein S, Brunne B, Schnitzer L, Mochmann HC, Arntz HR. Difficult prehospital endotracheal intubation - Predisposing factors in a physician based EMS. Resuscitation. 2011;82:1519–24. - PubMed