Survey of airway management strategies and experience of non-consultant doctors in intensive care units in the UK.

BACKGROUND: Airway problems continue to occur in intensive care setting. Management strategies, staffing, and availability of equipment can all have an influence.

METHODS: We undertook a standardized telephone survey of airway management strategies, staffing, and airway equipment availability in general intensive care units (ICUs) in the UK, before the reporting of the Fourth National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society.

RESULTS: All 257 UK general ICUs were contacted and 77% replied. At the time of the survey, 6.3% of all ICU patients were judged by respondents to have an increased risk of airway complications. While 38% of respondents reported using individualized airway management plans for patients with higher risk airways, only 19% of the patients identified as 'at risk' had such a plan in place. Action plans for the management of unanticipated tracheal tube and tracheostomy displacement were available in 7% and 10% of ICUs, respectively, although 27% of respondents reported no training in recognition and management of these events. Few respondents could describe the equipment available for emergency transtracheal access on their ICU and 13% had no training in its use. More than half of the respondents (56%) routinely used continuous waveform capnography for patients with artificial airways. A fibrescope was available to all ICUs: immediately in 63% and after >5 min in 14%. In 33% of ICUs, the most junior doctor providing out-of-hours cover had not always obtained the Royal College of Anaesthetists initial assessment of competency in anaesthesia. One-third of ICU residents also had commitments outside the ICU. An additional anaesthetist for managing airway emergencies was available in all ICUs with 80% being on-site.

CONCLUSIONS: There remains room for improvement in airway management strategies and resources in ICUs in the UK.