Airway Management in ICU Settings

Abstract

Maintenance of patent airway, adequate ventilation, and pulmonary gas exchange is very important in critically ill patients. Airway management in intensive care patients differs significantly from routine surgical procedures in the operating room. The airway competence in intensive care unit (ICU) should be coping with the rapidly evolving advances in airway management. Therefore, efforts should be focused on the three pillars of airway master: airway providers as intensivists or critical care physicians, equipment, and operational plans. Not all institutions can afford all airway equipment in the market; however, they should make sure that critical care providers have a full access to the available tools and they are comfortable using it. Educational sessions and refresher courses should be tailored to meet the competence level of the ICU providers and equipment availability. Operational plan includes developing institutional airway protocols and implementing difficult airway guidelines. The protocols should consider different staffing models of ICU and make sure all the time at least one member of the team with the highest experience in airway should be always available. The aim of writing this chapter is to enable the intensivist to optimize their use of airway equipment and managing highrisk patients in ICU.Keywords: tracheal intubation, videolaryngoscopy (VL), flexible fiberoptic intubation, bronchoscopy, percutaneous tracheostomy, extubation in ICU, high-flow nasal cannula (HFNC), virtual endoscopy (VE), airway ultrasound, supra-glottic airway devices, tube exchange © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Tracheal intubation in ICU IntroductionTracheal intubation (TI) is one of daily practiced procedures in the intensive care unit (ICU), especially when the patient has respiratory failure or cardiovascular collapse. It involves highly skilled techniques that require much of training, practice, and expertise. The excellence in airway management in ICU is necessary for intensivist's every day practice, which when it is lacking does not only compromise the quality of care but also has a potential impact on patient safety.The optimal intubation condition prevailing in surgical theaters differs a lot in nature than harsh and chaotic scenarios in ICU. The nature of those situations has three factors: the highly skilled anesthesiologists versus the intensivists; the compensated, well-controlled surgical patient versus the decompensated sick ICU patients; and equipment availability. That is why in ICU settings, the airway instrumentation-related complications have higher incidence than anesthesia settings. Among the contributory factors for high failure rates are the highly stressful environment, limited expertise level of the providers with different te...