Chapter 28 - Airway management in the ICU

Summary

Full monitoring and the presence of appropriately experienced staff are as important in the intensive care units (ICUs) as in the operating theatre when managing the airway and performing tracheal intubation. This chapter reviews tracheal intubation, choice of induction agents and muscle relaxants, safe tracheal extubation, tracheostomy and bronchoscopy in the critically ill patients. It summaries the basic patient machine interfaces used in continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV). Some patients tolerate a trial of extubation and a brief period of NIV. However others fail to manage even with CPAP and pressure support before getting tired, as indicated by poor cough, sweating, increasing pulse and respiratory rate (rapid shallow breaths). Tracheostomy tubes are frequently too short for the depth of stoma and should have an internal cannula. Bronchoscopy is increasingly performed in ventilated patients both as a diagnostic and therapeutic tool.