Management of the airway in intensive care

Airway management in intensive care is often routine; however there is a higher incidence of problems with a difficult airway that is under-reported. Management of these patients is by a multidisciplinary team who may have less familiarity and experience to manage the difficult airway than that which is commonly found in the operating theatre environment. In this article we explain the predictable and unpredictable aspects of airway management in this important group of patients. Particular emphasis is placed on the specific problems associated with extubation in the ICU and there is detailed discussion of the aspects of multiple organ failure that are commonly experienced in the critically ill patient and the impact they have on airway management. Problems with oxygen delivery and ventilation/perfusion mismatch are touched upon. The important role of early tracheostomy in the management of the complex airway in ICU is addressed in some detail. We also address the importance of non-technical skills, rehearsal and planning to increase the safe and effective management of airway problems in the critically ill. We provide generic suggestions for the drugs and equipment immediately required to optimise the safe management of these patients.