Management of the airway in intensive care

Airway management in the intensive care unit (ICU) is largely uneventful; there is a higher incidence of airway difficulties, however, than those encountered in the operating suite. Management of the airway in the ICU presents challenges unique to this environment that must be coped with by a multidisciplinary team that may be less experienced in airway management than clinicians in the operating theatre. The risks associated with this situation, I believe, may be ameliorated by planning and forethought. This article outlines some of the specific difficulties faced by clinicians in ICU and attempts to provide some guidance as to how these may be overcome, or at least abated. Drug choices are discussed, as are equipment choices. A suggestion for a difficult airway algorithm for use in the ICU is put forward. The timing of tracheostomy is discussed. Finally, the importance of the team and the human factors that are at play are touched upon.