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Published in: Critical Care 1/2019

Open Access 01-12-2019 | Laryngoscopy | Editorial

How I manage a difficult intubation

Authors: Jonathan D. Casey, Matthew W. Semler, Kevin High, Wesley H. Self

Published in: Critical Care | Issue 1/2019

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Excerpt

In this article, we review our approach to a difficult intubation in a critically ill adult who is not in cardiac arrest and located in an emergency department (ED) or intensive care unit (ICU). Tracheal intubation may be difficult for either anatomical or physiological reasons. An anatomically difficult intubation (sometimes referred to as a “difficult airway”) involves challenges in viewing the vocal cords (difficult laryngoscopy) or passing a tube into the trachea (difficult endotracheal tube placement). A physiologically difficult intubation involves cardiopulmonary compromise, typically manifested as hypoxemia or hypotension. …
Literature
1.
go back to reference Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251–70.CrossRefPubMed Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251–70.CrossRefPubMed
2.
go back to reference Levitan RM, Everett WW, Ochroch EA. Limitations of difficult airway prediction in patients intubated in the emergency department. Ann Emerg Med. 2004;44:307–13.CrossRefPubMed Levitan RM, Everett WW, Ochroch EA. Limitations of difficult airway prediction in patients intubated in the emergency department. Ann Emerg Med. 2004;44:307–13.CrossRefPubMed
3.
go back to reference Smith KA, High K, Collins SP, Self WH. A preprocedural checklist improves the safety of emergency department intubation of trauma patients. Acad Emerg Med. 2015;22:989–92.CrossRefPubMed Smith KA, High K, Collins SP, Self WH. A preprocedural checklist improves the safety of emergency department intubation of trauma patients. Acad Emerg Med. 2015;22:989–92.CrossRefPubMed
4.
go back to reference Chrimes N. The Vortex: a universal “high-acuity implementation tool” for emergency airway management. Br J Anaesth. 2016;117(Suppl 1):i20–7.CrossRefPubMed Chrimes N. The Vortex: a universal “high-acuity implementation tool” for emergency airway management. Br J Anaesth. 2016;117(Suppl 1):i20–7.CrossRefPubMed
5.
go back to reference Aziz MF, Dillman D, Fu R, Brambrink AM. Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway. Anesthesiology. 2012;116:629–36.CrossRefPubMed Aziz MF, Dillman D, Fu R, Brambrink AM. Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway. Anesthesiology. 2012;116:629–36.CrossRefPubMed
6.
go back to reference Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, et al. Effect of use of a bougie vs endotracheal tube and stylet on first-attempt intubation success among patients with difficult airways undergoing emergency intubation: a randomized clinical trial. JAMA. 2018;319:2179–89.CrossRefPubMedPubMedCentral Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, et al. Effect of use of a bougie vs endotracheal tube and stylet on first-attempt intubation success among patients with difficult airways undergoing emergency intubation: a randomized clinical trial. JAMA. 2018;319:2179–89.CrossRefPubMedPubMedCentral
7.
go back to reference Hill C, Reardon R, Joing S, Falvey D, Miner J. Cricothyrotomy technique using gum elastic bougie is faster than standard technique: a study of emergency medicine residents and medical students in an animal lab. Acad Emerg Med. 2010;17:666–9.CrossRefPubMed Hill C, Reardon R, Joing S, Falvey D, Miner J. Cricothyrotomy technique using gum elastic bougie is faster than standard technique: a study of emergency medicine residents and medical students in an animal lab. Acad Emerg Med. 2010;17:666–9.CrossRefPubMed
8.
go back to reference Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115:827–48.CrossRefPubMedPubMedCentral Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115:827–48.CrossRefPubMedPubMedCentral
9.
go back to reference McKown AC, Casey JD, Russell DW, Joffe AM, Janz DR, Rice TW, et al. Risk factors for and prediction of hypoxemia during tracheal intubation of critically ill adults. Ann Am Thorac Soc. 2018;15:1320–7.CrossRefPubMed McKown AC, Casey JD, Russell DW, Joffe AM, Janz DR, Rice TW, et al. Risk factors for and prediction of hypoxemia during tracheal intubation of critically ill adults. Ann Am Thorac Soc. 2018;15:1320–7.CrossRefPubMed
10.
go back to reference Baillard C, Fosse J-P, Sebbane M, Chanques G, Vincent F, Courouble P, et al. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med. 2006;174:171–7.CrossRefPubMed Baillard C, Fosse J-P, Sebbane M, Chanques G, Vincent F, Courouble P, et al. Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med. 2006;174:171–7.CrossRefPubMed
11.
go back to reference Casey JD, Janz DR, Russell DW, Vonderhaar DJ, Joffe AM, Dischert KM, et al. Bag-mask ventilation during tracheal intubation of critically ill adults. N Engl J Med. 2019;380:811–21.CrossRefPubMed Casey JD, Janz DR, Russell DW, Vonderhaar DJ, Joffe AM, Dischert KM, et al. Bag-mask ventilation during tracheal intubation of critically ill adults. N Engl J Med. 2019;380:811–21.CrossRefPubMed
12.
go back to reference Frat J-P, Ricard J-D, Quenot J-P, Pichon N, Demoule A, Forel J-M, et al. Non-invasive ventilation versus high-flow nasal cannula oxygen therapy with apnoeic oxygenation for preoxygenation before intubation of patients with acute hypoxaemic respiratory failure: a randomised, multicentre, open-label trial. Lancet Respir Med. 2019;7(4):303–12.CrossRefPubMed Frat J-P, Ricard J-D, Quenot J-P, Pichon N, Demoule A, Forel J-M, et al. Non-invasive ventilation versus high-flow nasal cannula oxygen therapy with apnoeic oxygenation for preoxygenation before intubation of patients with acute hypoxaemic respiratory failure: a randomised, multicentre, open-label trial. Lancet Respir Med. 2019;7(4):303–12.CrossRefPubMed
13.
go back to reference Vourc’h M, Asfar P, Volteau C, Bachoumas K, Clavieras N, Egreteau P-Y, et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med. 2015;41:1538–48.CrossRefPubMed Vourc’h M, Asfar P, Volteau C, Bachoumas K, Clavieras N, Egreteau P-Y, et al. High-flow nasal cannula oxygen during endotracheal intubation in hypoxemic patients: a randomized controlled clinical trial. Intensive Care Med. 2015;41:1538–48.CrossRefPubMed
14.
go back to reference Perbet S, De Jong A, Delmas J, Futier E, Pereira B, Jaber S, et al. Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study. Crit Care. 2015;19:257.CrossRefPubMedPubMedCentral Perbet S, De Jong A, Delmas J, Futier E, Pereira B, Jaber S, et al. Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study. Crit Care. 2015;19:257.CrossRefPubMedPubMedCentral
15.
go back to reference Jabre P, Combes X, Lapostolle F, Dhaouadi M, Ricard-Hibon A, Vivien B, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet. 2009;374:293–300.CrossRefPubMed Jabre P, Combes X, Lapostolle F, Dhaouadi M, Ricard-Hibon A, Vivien B, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet. 2009;374:293–300.CrossRefPubMed
Metadata
Title
How I manage a difficult intubation
Authors
Jonathan D. Casey
Matthew W. Semler
Kevin High
Wesley H. Self
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2451-4

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