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Intensivist Management of Difficult Airway Problems

To plan for airway management, intensivists must answer several questions, including whether endotracheal intubation is necessary, whether supralaryngeal ventilation, via mask or laryngeal mask airway, can be achieved, whether the patient is at risk for aspiration, and finally whether the patient can tolerate apnea for any duration. Based on the answers to these questions, the practitioner may not choose endotracheal intubation using laryngoscopy but rather choose an alternate approach to airway management. Intensivists need to be aware of the data regarding the complication that occur with multiple attempts at laryngoscopy. The data regarding airway assessment are presented, as the negative predictive value of the assessments tests are high and can reassure practitioners. Several popular alternate airway management techniques are presented; the intensivist needs to be familiar with at least 1 technique as well as knowledgeable about achieving an emergency airway.