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Review
. 2023 Oct;68(10):1438-1448.
doi: 10.4187/respcare.10821. Epub 2023 May 23.

Approach to the Physiologically Challenging Endotracheal Intubation in the Intensive Care Unit

Andrew J Hickey  1 , Matthew J Cummings  1 , Briana Short  1 , Daniel Brodie  1   2 , Oliver Panzer  3 , Purnema Madahar  1 , Max R O'Donnell  4   5
Affiliations
Review

Approach to the Physiologically Challenging Endotracheal Intubation in the Intensive Care Unit

Andrew J Hickey et al. Respir Care. 2023 Oct.

Abstract

Endotracheal intubation for airway management is a common procedure in the ICU. Intubation may be difficult due to anatomic airway abnormalities but also due to physiologic derangements that predispose patients to cardiovascular collapse during the procedure. Results of studies demonstrate a high incidence of morbidity and mortality associated with airway management in the ICU. To reduce the likelihood of complications, medical teams must be well versed in the general principles of intubation and be prepared to manage physiologic derangements while securing the airway. In this review, we present relevant literature on the approach to endotracheal intubation in the ICU and provide pragmatic recommendations relevant to medical teams performing intubations in patients who are physiologically unstable.

Keywords: endotracheal intubation; intensive care unit; physiologically difficult airway.

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Conflict of interest statement

The authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Physiologically difficult airway algorithm. OSA = obstructive sleep apnea; NIV = noninvasive ventilation; HFNC = high-flow nasal cannula; BMV = bag-mask ventilation; IVF = intravenous fluid; DL = direct laryngoscopy; VL = video laryngoscopy; SGA = suppraglottic airway.
See this image and copyright information in PMC

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