The Difficult Airway in Adult Critical Care

Gavin G. Lavery, MD, FCARSCI, MB, BCh, BAO; Brian V. McCloskey, MB, BCh, FRCA, FFARCSI, MRCP


Crit Care Med. 2008;36(7):2163-2173. 

In This Article

Unanticipated Airway Difficulty

The unanticipated difficult airway allows only a short period to solve the problem if significant hypoxemia, hypercarbia, and hemodynamic instability are to be avoided. The patient is usually anesthetized, may be apneic, and may have had muscle relaxants and several unsuccessful attempts at intubation. If appropriate equipment, assistance, and experience are not immediately at hand, there is little time to obtain these. Oxygenation must be maintained and hypercapnia avoided.

If the practitioner is inexperienced, the patient has had no (or a relatively short-acting) muscle relaxant and manual ventilation is not a problem, it may be appropriate to let the patient recover consciousness. An awake intubation can then be planned either after a short period of recovery or on another occasion. With an experienced practitioner, it may be possible to continue using techniques to improve the chances of visualizing and intubating the larynx. The adjuncts described subsequently may be useful in this situation, but also for the anesthetized patient with an anticipated difficult airway.


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