Difficult airway management in the intensive care unit: practical guidelines.

OBJECTIVE: To review the management of the difficult airway in the intensive care unit patient.

DATA SOURCES: A review of publications reported from 1975-2002 and identified in both the Medline and Pubmed databases on the management of the difficult airway. The publications were also assessed for their relevance to the intensive care setting.

SUMMARY OF REVIEW: Endotracheal intubation is performed infrequently in the intensive care unit and usually in patients who have a higher than average rate of difficulty. The consequences of inadequate airway management can be devastating not only for the patient, but psychologically for the staff involved in whom airway management should be a core skill. Most of the reports reviewing the management of patients with a difficult airway are found in the field of anaesthesia and to a lesser extent in the field of emergency medicine. This review looks at the application of all the reported literature for difficult airway management in the intensive care setting. We propose guidelines that may assist both the trainee in intensive care medicine and the experienced intensivist in the management of the airway in the intensive care patient.

CONCLUSIONS: The principles of difficult airway management, including a back-up plan and calling for assistance early, hold true in the intensive care setting as much as in any other clinical setting. It is vital that clinicians develop their own difficult airway algorithm based on their training and experience.