title: The Physiologically Difficult Airway.
abstract: Airway management in critically ill patients involves the identification and management of the potentially difficult airway in order to avoid untoward complications. This focus on difficult airway management has traditionally referred to identifying anatomic characteristics of the patient that make either visualizing the glottic opening or placement of the tracheal tube through the vocal cords difficult. This paper will describe the physiologically difficult airway, in which physiologic derangements of the patient increase the risk of cardiovascular collapse from airway management. The four physiologically difficult airways described include hypoxemia, hypotension, severe metabolic acidosis, and right ventricular failure. The emergency physician should account for these physiologic derangements with airway management in critically ill patients regardless of the predicted anatomic difficulty of the intubation.
authors.affiliation: University of Arizona, Department of Emergency Medicine, Tucson, Arizona; University of Arizona, Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep, Tucson, Arizona.
authors.forename: Jarrod M
authors.initials: JM
authors.lastname: Mosier
authors.affiliation: University of Arizona, Department of Emergency Medicine, Tucson, Arizona; University of Arizona, Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep, Tucson, Arizona.
authors.forename: Raj
authors.initials: R
authors.lastname: Joshi
authors.affiliation: University of Arizona, Department of Emergency Medicine, Tucson, Arizona; University of Arizona, Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep, Tucson, Arizona.
authors.forename: Cameron
authors.initials: C
authors.lastname: Hypes
authors.affiliation: University of Arizona, Department of Emergency Medicine, Tucson, Arizona.
authors.forename: Garrett
authors.initials: G
authors.lastname: Pacheco
authors.affiliation: University of Arizona, Department of Emergency Medicine, Tucson, Arizona.
authors.forename: Terence
authors.initials: T
authors.lastname: Valenzuela
authors.affiliation: University of Arizona, Department of Emergency Medicine, Tucson, Arizona.
authors.forename: John C
authors.initials: JC
authors.lastname: Sakles
mesh_terms: D000138:Acidosis / Q000628:therapy; D058109:Airway Management / Q000379:methods*; D016638:Critical Illness; D005931:Glottis / Q000033:anatomy & histology / Q000502:physiology; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D007022:Hypotension / Q000628:therapy; D000860:Hypoxia / Q000628:therapy; D007442:Intubation, Intratracheal / Q000379:methods; D012307:Risk Factors