Difficult Intubation Guidelines and Failed Airway Management

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

Jo Hackney and

Edited by

Debashish Dutta and

Ned Gilbert-Kawai: Affiliation:
The Royal Liverpool Hospital
Debashish Dutta: Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann: Affiliation:
Royal Berkshire Hospital, Reading

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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).

Keywords

difficult airway difficult airway trolley guidelines tracheostomy airway emergency

Type: Chapter
Information: Intensive Care Medicine
The Essential Guide
, pp. 526 - 533

DOI: https://doi.org/10.1017/9781108989060 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2021

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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.CrossRef Google 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.CrossRef Google Scholar PubMed

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.CrossRef Google Scholar PubMed