Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Introduction
- Classification of Devices
- Fixed-Performance Devices
- Variable Performance Devices
- Introduction: The 4th National Audit Project
- Anatomy
- Approaches
- Difficult Airway Society’s Recommended Technique
- Introduction: NAP4
- How to Predict an Anatomically Difficult Airway
- Equipment
- Difficult Airway Society Guidelines and Airway Management in Critically Ill Adults
- Tracheostomy difficulties
- Introduction
- Indications for Bronchoscopy in the ICU
- Contraindications
- Procedure
- Complications
- Conclusion
- Introduction
- Pre-procedural Considerations
- Procedure
- Post-procedure
- Acknowledgements
- Introduction
- Indications
- Contraindications (Relative)
- Technique for Insertion
- Drainage Bottles
- Pneumothorax Management
- Analysis of Fluid
- Complications
- Introduction
- Diagnosis of Acute Respiratory Failure
- Ultrasound in the Role of Weaning from Mechanical Ventilation
- Pleural Effusions
- Distinguishing Atelectasis from Pneumonia
- Ultrasound to Distinguish ARDS from Cardiac Pulmonary Oedema
- Introduction
- Spirometry
- Inspiratory and Expiratory Flow–Volume Loops in Upper Airway Obstruction
- Bronchodilator Response and Reversibility
- Lung Volumes
- Disease Patterns
- Gas Transfer
- Indications
- Contraindications to Line Insertion
- Risks/Complications
- Potential Insertion Sites
- Allen’s Test
- Procedure
- Introduction
- Localisation of Vasculature
- Techniques for Ultrasound-Guided Peripheral Vascular Access
- Introduction
- Indications
- Contraindications
- Complications
- Ultrasound
- Sites
- Procedure
- Confirmation of Line Placement
- Arterial Puncture
- Introduction
- Equipment Components
- Procedure
- Interpretation
- Clinical Use of Pulmonary Artery Catheters
- Complications
- Introduction
- Pad Positions
- Defibrillation
- Summary of Defibrillation Protocol in Advanced Life Support
- Optimising Defibrillation
- Oxygen
- Drugs in Defibrillation
- Energy Levels
- Implantable Cardioverter–Defibrillators
- Cardioversion outside the Cardiac Arrest Situation
- Complications
- Introduction
- Temporary
- Permanent Transvenous
- Miscellaneous
- Basic Pacing Concepts – Sensing and Capture
- Modes of Operation
- Management of Temporary Systems in the ICU
- Management of Permanent Systems in the ICU
- Pathophysiology of Cardiac Tamponade
- Aetiology of Pericardial Effusion
- Diagnosis
- Indications for Pericardiocentesis
- Contraindications of Pericardiocentesis
- Procedure
- Complications of Pericardiocentesis
- Introduction
- Pulmonary Artery Catheters
- Transoesophageal Echocardiography
- Doppler Devices
- Pulse Pressure Analysis
- Non-invasive Techniques
- Research Tools
- Introduction
- Lead placement and FICE views
- The Essence of FICE
- Common Pathologies Identified
- Acknowledgements
- Introduction
- Indications
- Contraindications
- Lumbar Punctures in the Emergency Setting
- Equipment and Technique
- Samples to Send
- Interpreting Results in Suspected Meningitis
- Complications
- Introduction
- Indications
- Anatomy, Physiology and Pharmacology
- Epidural Regimes
- Assessment and Monitoring
- Troubleshooting
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Volume Replacement
- Analysis of Fluid
- Complications
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Aftercare
- Complications
- Introduction
- Indications
- Contraindications
- Risks/Complications
- Procedure
- Additional Points
- Section 5.1 Practical Respiratory System
- 5.1.1 Oxygen Administration in Intensive Care
- 5.1.2 Emergency Front of Neck Airway Management
- 5.1.3 Difficult Intubation Guidelines and Failed Airway Management
- 5.1.4 Principles of Performing Fibreoptic Bronchoscopy and Broncho-alveolar Lavage in the Intubated Patient
- 5.1.5 Percutaneous Tracheostomies and Management of Tracheostomy Emergencies
- 5.1.6 Chest Drain Insertion
- 5.1.7 Lung Ultrasound
- 5.1.8 Lung Function Testing
- Section 5.2 Practical Cardiovascular System
- Section 5.3 Practical Central Nervous System
- Section 5.4 Practical Gastrointestinal System
- Section 5.5 Practical Genitourinary System
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
5.1.3 - Difficult Intubation Guidelines and Failed Airway Management
from Section 5.1 - Practical Respiratory System
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Introduction
- Classification of Devices
- Fixed-Performance Devices
- Variable Performance Devices
- Introduction: The 4th National Audit Project
- Anatomy
- Approaches
- Difficult Airway Society’s Recommended Technique
- Introduction: NAP4
- How to Predict an Anatomically Difficult Airway
- Equipment
- Difficult Airway Society Guidelines and Airway Management in Critically Ill Adults
- Tracheostomy difficulties
- Introduction
- Indications for Bronchoscopy in the ICU
- Contraindications
- Procedure
- Complications
- Conclusion
- Introduction
- Pre-procedural Considerations
- Procedure
- Post-procedure
- Acknowledgements
- Introduction
- Indications
- Contraindications (Relative)
- Technique for Insertion
- Drainage Bottles
- Pneumothorax Management
- Analysis of Fluid
- Complications
- Introduction
- Diagnosis of Acute Respiratory Failure
- Ultrasound in the Role of Weaning from Mechanical Ventilation
- Pleural Effusions
- Distinguishing Atelectasis from Pneumonia
- Ultrasound to Distinguish ARDS from Cardiac Pulmonary Oedema
- Introduction
- Spirometry
- Inspiratory and Expiratory Flow–Volume Loops in Upper Airway Obstruction
- Bronchodilator Response and Reversibility
- Lung Volumes
- Disease Patterns
- Gas Transfer
- Indications
- Contraindications to Line Insertion
- Risks/Complications
- Potential Insertion Sites
- Allen’s Test
- Procedure
- Introduction
- Localisation of Vasculature
- Techniques for Ultrasound-Guided Peripheral Vascular Access
- Introduction
- Indications
- Contraindications
- Complications
- Ultrasound
- Sites
- Procedure
- Confirmation of Line Placement
- Arterial Puncture
- Introduction
- Equipment Components
- Procedure
- Interpretation
- Clinical Use of Pulmonary Artery Catheters
- Complications
- Introduction
- Pad Positions
- Defibrillation
- Summary of Defibrillation Protocol in Advanced Life Support
- Optimising Defibrillation
- Oxygen
- Drugs in Defibrillation
- Energy Levels
- Implantable Cardioverter–Defibrillators
- Cardioversion outside the Cardiac Arrest Situation
- Complications
- Introduction
- Temporary
- Permanent Transvenous
- Miscellaneous
- Basic Pacing Concepts – Sensing and Capture
- Modes of Operation
- Management of Temporary Systems in the ICU
- Management of Permanent Systems in the ICU
- Pathophysiology of Cardiac Tamponade
- Aetiology of Pericardial Effusion
- Diagnosis
- Indications for Pericardiocentesis
- Contraindications of Pericardiocentesis
- Procedure
- Complications of Pericardiocentesis
- Introduction
- Pulmonary Artery Catheters
- Transoesophageal Echocardiography
- Doppler Devices
- Pulse Pressure Analysis
- Non-invasive Techniques
- Research Tools
- Introduction
- Lead placement and FICE views
- The Essence of FICE
- Common Pathologies Identified
- Acknowledgements
- Introduction
- Indications
- Contraindications
- Lumbar Punctures in the Emergency Setting
- Equipment and Technique
- Samples to Send
- Interpreting Results in Suspected Meningitis
- Complications
- Introduction
- Indications
- Anatomy, Physiology and Pharmacology
- Epidural Regimes
- Assessment and Monitoring
- Troubleshooting
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Volume Replacement
- Analysis of Fluid
- Complications
- Introduction
- Indications
- Contraindications
- Technique for Insertion
- Aftercare
- Complications
- Introduction
- Indications
- Contraindications
- Risks/Complications
- Procedure
- Additional Points
- Section 5.1 Practical Respiratory System
- 5.1.1 Oxygen Administration in Intensive Care
- 5.1.2 Emergency Front of Neck Airway Management
- 5.1.3 Difficult Intubation Guidelines and Failed Airway Management
- 5.1.4 Principles of Performing Fibreoptic Bronchoscopy and Broncho-alveolar Lavage in the Intubated Patient
- 5.1.5 Percutaneous Tracheostomies and Management of Tracheostomy Emergencies
- 5.1.6 Chest Drain Insertion
- 5.1.7 Lung Ultrasound
- 5.1.8 Lung Function Testing
- Section 5.2 Practical Cardiovascular System
- Section 5.3 Practical Central Nervous System
- Section 5.4 Practical Gastrointestinal System
- Section 5.5 Practical Genitourinary System
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. Poor airway assessment and planning and failure to follow guidelines were highlighted as major issues in the Royal College of Anaesthetists 4th National Audit Project (NAP4). A lack of equipment was identified as an issue particularly prevalent in the intensive care environment.
2. Factors which enable prediction of a difficult airway should be assessed for early to allow appropriate forward planning.
3. It is important to have a well-organised, appropriately stocked and signposted difficult airway trolley, with regular teaching and updates to ensure all staff groups are familiar with the equipment.
4. Thorough knowledge of the Difficult Airway Society’s guidelines on how to manage an unpredicted difficult airway in adults is essential. As of 2018, these include one specific to the intensive care unit – ‘Guidelines for the management of tracheal intubation in critically ill adults’.
5. One must be able to appreciate the differences in emergency management of a tracheostomy (with a patent upper airway) and a laryngectomy (without a patent upper airway).
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 526 - 533Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Cook, T, Woodall, N, Frerk, C. NAP4: Major complications of airway management in the United Kingdom. Report and findings March 2011. 4th National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society. London: The Royal College of Anaesthetists; 2011.Google Scholar
Crawley, SM, Dalton, AJ. Predicting the difficult airway. Contin Educ Anaesth Crit Care Pain 2015;15:253–7.Google Scholar
Frerk, C, Mitchell, VS, McNarry, AF, et al.; Difficult Airway Society intubation guidelines working group. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015;115:827–48.CrossRefGoogle Scholar
Higgs, A, McGrath, BA, Goddard, C, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth 2018;120:323–52.Google Scholar
McGrath, BA, Bates, L, Atkinson, D, et al. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia 2012;67:1025–41.CrossRefGoogle ScholarPubMed
Seo, S-H, Lee, J-G, Yu, S-B, et al. Predictors of difficult intubation defined by the intubation difficulty scale (IDS): predictive value of 7 airway assessment factors. Korean J Anesthesiol 2012;63:491–7.CrossRefGoogle ScholarPubMed