Difficult airway management in the intensive care unit: alternative techniques.
OBJECTIVE
To review alternative airway management techniques and their suitability to the intensive care setting.


METHODS
A review of publications reported from 1975-2002 and identified in both the Medline and Pubmed databases on the products used in the management of a difficult airway. In addition new airway devices were identified by accessing the product catalogues of major manufacturers and third-party vendors. The publications were assessed for their relevance to the intensive care setting.


RESULTS
Many devices to manage the difficult airway have been designed for use in the controlled environment of an anaesthetic room rather than the intensive care unit. In addition, there is very little opportunity to evaluate and train with alternative techniques in real-life situations in the critical care setting. We review products that are considered as alternative airway devices to the standard endotracheal tube and include alternative intubating devices to the standard laryngoscope and devices to achieve a trans-tracheal airway. We also consider their suitability to the intensive care setting.


CONCLUSIONS
There is a wide range of techniques available to manage the difficult airway. Due to the limited opportunity to train in the use of alternative airway techniques, such techniques should ideally involve an extension of those skills commonly practised by intensivists (e.g. bronchoscopy). Ultimately, the most important features when choosing a technique to manage a difficult airway are the training, knowledge and experience of the practitioner.
Intensive Care Centre, St Vincent's Hospital, Melbourne, Victoria. michael.lim@talk21.com
M S T
MS
Lim
J J
JJ
Hunt-Smith