Airway Management in Critical Illness

Expertise in airway management is a vital skill for any provider caring for critically ill patients. A growing body of literature has identified the stark difference in periprocedural outcomes of elective intubation in the operating room when compared with emergency intubation in the ICU. A number of strategies to reduce the morbidity and mortality associated with airway management in the critically ill have been described. In this review, we provide an updated framework for airway assessment before direct laryngoscopy and video laryngoscopy, and use of newer pharmacologic agents; comment on current concepts in tracheal intubation in the ICU; and address human factors around critical decision-making during ICU airway management. Expertise in airway management is a vital skill for any provider caring for critically ill patients. A growing body of literature has identified the stark difference in periprocedural outcomes of elective intubation in the operating room when compared with emergency intubation in the ICU. A number of strategies to reduce the morbidity and mortality associated with airway management in the critically ill have been described. In this review, we provide an updated framework for airway assessment before direct laryngoscopy and video laryngoscopy, and use of newer pharmacologic agents; comment on current concepts in tracheal intubation in the ICU; and address human factors around critical decision-making during ICU airway management. Response to Airway Management in Critically Ill Patients: Don’t Forget the Bronchoscope!CHESTVol. 157Issue 6PreviewWe read with interest the article by Scott et al1 regarding airway management in critically ill patients in a recent issue of CHEST (April 2020) and agree with many of the author’s recommendations. Interestingly though, there was no mention of the use and technique of fiber-optic bronchoscopic intubation (FOI) when a clinical situation warrants direct visualization of not only the vocal cords but also the trachea, and for those patients where an upright, semi-awake endotracheal intubation seems prudent. Full-Text PDF ResponseCHESTVol. 157Issue 6PreviewWe thank Russotto et al for their interest in our review1 and for providing further insight into preoxygenation methods prior to laryngoscopy and intubation. Although we mentioned the combination of noninvasive ventilation (NIV) with high flow nasal cannula (HFNC) to be superior to bag-valve mask (BVM) in preventing hypoxemia during intubation, we did not explicitly reference the investigation by Baillard et al,2 which showed that NIV alone is superior to BVM. We appreciate their reference to the investigation by Frat et al3 comparing preoxygenation by HFNC with NIV. Full-Text PDF ResponseCHESTVol. 158Issue 6PreviewWe thank Gómez-Ríos and Casans-Francés for their interest in our review1 and for highlighting standard usage of waveform capnography, airway ultrasound scanning, consideration of apneic oxygenation, and the importance of sound planning around tracheal extubation. Full-Text PDF Airway Management in Critically Ill AdultsCHESTVol. 158Issue 6PreviewWe read with interest the review of Scott et al1 in CHEST (April 2020). We believe it is necessary to highlight core topics that have remained in the pipeline. Full-Text PDF Preoxygenation of Critically Ill Patients With Acute Hypoxemic Respiratory FailureCHESTVol. 157Issue 6PreviewWe congratulate Scott et al1 for their comprehensive update on airway management in the critical ill in a recent issue of CHEST (April 2020). Recent literature provides relevant insights on the ability of different preoxygenation methods to reduce the risk of severe hypoxemia during tracheal intubation in the critically ill.2 Hence, we think that in the section on Preoxygenation and Ventilation Strategies, it might have been worth providing more details on the current evidence, comparing preoxygenation methods.