title: Techniques for the difficult airway.
abstract: OBJECTIVE
  Management of the difficult airway is associated with significant morbidity and mortality in critically ill patients. An increasing array of advanced airway tools are available, but appropriate selection and application in the ICU remains poorly defined.
  
  
  RESULTS
  Difficult airway incidence during emergent intubation is 10%, but complications of ICU airway management remain common. Training and equipment in many ICUs remain variable despite data that demonstrate that an 'intubation management bundle' and a systematic approach to teamwork and training can reduce life-threatening airway complications. A protocol employing an extraglottic airway (EGA) early in cases of inadequate ventilation has been associated with no episodes of prolonged hypoxemia in 12 225 consecutive intubations. Direct laryngoscopy with gum elastic bougie is the most commonly employed method to manage emergent difficult airways, and videolaryngoscopes also provide greater glottic visualization and a high rate of intubation success in patients with difficult airway risk factors or a failed airway.
  
  
  CONCLUSIONS
  A systematic approach to intubation that emphasizes planning and teamwork can reduce intubation complications. Early use of an EGA or cricothyroidotomy may reduce complications when oxygenation is inadequate. Use of a gum elastic bougie or indirect optical device is also associated with a high rate of intubation success when oxygenation permits.
authors.affiliation: Department of Medicine, Madigan Healthcare System and Uniformed Services University of the Health Sciences, Tacoma, WA 98431, USA. alexander.niven@us.army.mil
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Niven
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Doerschug
mesh_terms: D058109:Airway Management / Q000379:methods*; D000758:Anesthesia / Q000379:methods; D002983:Clinical Competence; D016638:Critical Illness; D006801:Humans; D000860:Hypoxia / Q000517:prevention & control / Q000628:therapy*; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000379:methods; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012131:Respiratory Insufficiency / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors