Maximizing Success for Physiologically Difficult Airway (PDA) Management in the ICU

Features| April 2024 Maximizing Success for Physiologically Difficult Airway (PDA) Management in the ICU Graham T. Lubinsky, MD, FASA; Graham T. Lubinsky, MD, FASA Search for other works by this author on: This Site PubMed Google Scholar Craig S. Jabaley, MD, FCCM; Craig S. Jabaley, MD, FCCM Search for other works by this author on: This Site PubMed Google Scholar Kunal Karamchandani, MD, FCCP, FCCM; Kunal Karamchandani, MD, FCCP, FCCM Search for other works by this author on: This Site PubMed Google Scholar Nathan J. Smischney, MD, MSc, FASA Nathan J. Smischney, MD, MSc, FASA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor April 2024, Vol. 88, 22–23. https://doi.org/10.1097/01.ASM.0001010676.31445.76 Views Icon Views Article contents Figures Maximizing Success for Physiologically Difficult Airway (PDA) Management in the ICU. ASA Monitor 2024; 88:22–23 doi: https://doi.org/10.1097/01.ASM.0001010676.31445.76 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: intensive care unit, intubation, difficult, intubation Tracheal intubation (TI) in critically ill adults is associated with significant morbidity and mortality. In a landmark international observational study, major adverse events were observed in 45% of patients, with hemodynamic collapse being the most common, followed by hypoxemia (JAMA 2021;325:1164-72). Moreover, patients experiencing peri-intubation hemodynamic instability were at a heightened risk of 28-day mortality. Conceptually, critically ill adults may have a "physiologically difficult airway (PDA)," predisposing them to cardiorespiratory complications during or after TI, due to relevant comorbid disease and other risk factors (Table) (West J Emerg Med 2015;16:1109-17). The combination of sympatholysis due to anesthetic agents used for induction, increased intrathoracic pressure when converting from spontaneous to positive pressure ventilation, and the amelioration of the hypoxemia- and hypercarbia-associated sympathetic drive predisposes at-risk patients to hemodynamic collapse around the time of intubation. It is essential to evaluate patients undergoing TI for a PDA... You do not currently have access to this content.