title: Strategies to improve first attempt success at intubation in critically ill patients.
abstract: Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient's tolerance for repeated or prolonged attempts at laryngoscopy and, as a result, hypoxaemia and haemodynamic deterioration are common complications. Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the 'difficult airway' in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.
authors.affiliation: Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ 85724.
authors.forename: B S
authors.initials: BS
authors.lastname: Natt
authors.affiliation: Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ 85724.
authors.forename: J
authors.initials: J
authors.lastname: Malo
authors.affiliation: Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ 85724 Department of Emergency Medicine, University of Arizona College of Medicine, 1609 N. Warren Ave, Tucson, AZ 85724, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Hypes
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, 1609 N. Warren Ave, Tucson, AZ 85724, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Sakles
authors.affiliation: Division of Pulmonary, Critical Care, Allergy and Sleep, Department of Medicine, University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ 85724 Department of Emergency Medicine, University of Arizona College of Medicine, 1609 N. Warren Ave, Tucson, AZ 85724, USA jmosier@aemrc.arizona.edu.
authors.forename: J M
authors.initials: JM
authors.lastname: Mosier
mesh_terms: D058109:Airway Management / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D000768:Anesthesia, General / Q000379:methods; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D004630:Emergencies; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods / Q000592:standards; D010102:Oxygen Inhalation Therapy / Q000379:methods
keywords: airway management; critical care; emergency department; emergency medicine; intensive care; intubation; laryngoscopy; prehospital