title: The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit.
abstract: Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often life-saving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with a suboptimal evaluation of the airway and limited oxygen reserves despite adequate pre-oxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxaemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. Non-invasive positive pressure ventilation during pre-oxygenation improves oxygen stores in patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnoea before the occurrence of hypoxaemia. High-flow nasal cannula oxygenation at 60-70 L/min may also increase safety during TI in critically ill patients. Stable haemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.
authors.affiliation: Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Sheila Nainan
authors.initials: SN
authors.lastname: Myatra
authors.affiliation: Department of Anaesthesiology and Critical Care, J N Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India.
authors.forename: Syed Moied
authors.initials: SM
authors.lastname: Ahmed
authors.affiliation: Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kundra
authors.affiliation: Department of Onco-Anaesthesiology and Palliative Medicine, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Garg
authors.affiliation: Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India.
authors.forename: Venkateswaran
authors.initials: V
authors.lastname: Ramkumar
authors.affiliation: Kailash Cancer Hospital and Research Centre, Vadodara, Gujarat, India; Department of Anaesthesia, Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, India.
authors.forename: Apeksh
authors.initials: A
authors.lastname: Patwa
authors.affiliation: Kailash Cancer Hospital and Research Centre, Vadodara, Gujarat, India; Department of Anaesthesia, Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India.
authors.forename: Ubaradka S
authors.initials: US
authors.lastname: Raveendra
authors.affiliation: Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India.
authors.forename: Sumalatha Radhakrishna
authors.initials: SR
authors.lastname: Shetty
authors.affiliation: Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Jeson Rajan
authors.initials: JR
authors.lastname: Doctor
authors.affiliation: Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Dilip K
authors.initials: DK
authors.lastname: Pawar
authors.affiliation: Department of Anaesthesia, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India.
authors.forename: Singaravelu
authors.initials: S
authors.lastname: Ramesh
authors.affiliation: Department of Anaesthesiology, North Bengal Medical College, Darjeeling, West Bengal, India.
authors.forename: Sabyasachi
authors.initials: S
authors.lastname: Das
authors.affiliation: Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India.
authors.forename: Jigeeshu Vasishtha
authors.initials: JV
authors.lastname: Divatia
keywords: Complications; emergency department; intensive care; intubation bundle; ketamine; non-invasive positive pressure ventilation; tracheal intubation