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

Retrograde Intubation

Under local anesthesia, a cannula is inserted through the cricothyroid membrane into the trachea (Fig. 1.1) and a guidewire is passed through the needle upward through the vocal cords into the pharynx or mouth.[86,87] If necessary, forceps may be used to retrieve the guidewire and bring it out through the mouth (Fig. 1.2). The wire is then used to guide an ETT (railroaded over an endotracheal exchange catheter) through the vocal cords (Fig. 1.3) before the withdrawal of the wire through the cannula and further advancement of the ETT into the trachea (Fig. 1.4). A common variation to this technique is to use the wire to guide a fiberoptic scope through the vocal cords, thus facilitating a fiberoptically guided intubation.[86,87,88] With this technique, the wire must be longer than the fiberoptic scope plus the airway down to the glottis. A long angiography guidewire is appropriate, whereas a central venous catheter guidewire is not.

The technique of retrograde intubation (see text).


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