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

Failure to Intubate and Failure to Ventilate

This is an absolute emergency and a grave threat to life. To ensure all involved perform at their best, it is important to remain calm and follow an appropriate algorithm. The options are to find a satisfactory method of ventilation without intubation (noninvasive) or to perform a cricothyroidotomy or (potentially) tracheostomy.[1,2,75] Reduced to its simplest, the options are a) check the basics to see if intubating conditions can be improved; b) use of a supraglottic airway; or c) perform a cricothyroidotomy (Fig. 6), which may be more easily remembered using the phrase Fiddle, Larry, Stick.[136] Once ventilation and oxygenation is achieved, the options are wake up or continue using further options undertaken in a controlled manner with additional help.

Simple flow chart for the cannot intubate-cannot ventilate. Reproduced with permission from Mulcahy AJ, Yentis SM: Management of the Unexpected Difficult Airway. Anesthesia. Oxford, Wiley-Blackwell Publishing Ltd, 2005. LMA, laryngeal mask airway.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.