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Intensive Care Medicine
Published in: Intensive Care Medicine 10/2022

20-08-2022 | Laryngoscopy | Narrative Review

How to improve intubation in the intensive care unit. Update on knowledge and devices

Authors: Audrey De Jong, Sheila Nainan Myatra, Oriol Roca, Samir Jaber

Published in: Intensive Care Medicine | Issue 10/2022

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Abstract

Tracheal intubation in the critically ill is associated with serious complications, mainly cardiovascular collapse and severe hypoxemia. In this narrative review, we present an update of interventions aiming to decrease these complications. MACOCHA is a simple score that helps to identify patients at risk of difficult intubation in the intensive care unit (ICU). Preoxygenation combining the use of inspiratory support and positive end-expiratory pressure should remain the standard method for preoxygenation of hypoxemic patients. Apneic oxygenation using high-flow nasal oxygen may be supplemented, to prevent further hypoxemia during tracheal intubation. Face mask ventilation after rapid sequence induction may also be used to prevent hypoxemia, in selected patients without high-risk of aspiration. Hemodynamic optimization and management are essential before, during and after the intubation procedure. All these elements can be integrated in a bundle. An airway management algorithm should be adopted in each ICU and adapted to the needs, situation and expertise of each operator. Videolaryngoscopes should be used by experienced operators.
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Metadata
Title
How to improve intubation in the intensive care unit. Update on knowledge and devices
Authors
Audrey De Jong
Sheila Nainan Myatra
Oriol Roca
Samir Jaber
Publication date
20-08-2022
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 10/2022
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-022-06849-0

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