0
Editorials: Point/Counterpoint Editorials |

Point: Should an Anesthesiologist Be the Specialist of Choice in Managing the Difficult Airway in the ICU? YesAnesthesiologist for Airway in ICU? Yes

J. Matthias Walz, MD, FCCP
Author and Funding Information

From the Department of Anesthesiology, Division of Critical Care Medicine, UMass Memorial Medical Center.

Correspondence to: J. Matthias Walz, MD, FCCP, Department of Anesthesiology, Division of Critical Care Medicine, UMass Memorial Medical Center, 55 Lake Ave N, Worcester, MA 01655; e-mail: matthias.walz@umassmemorial.org


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(6):1372-1374. doi:10.1378/chest.12-2194
Text Size: A A A
Published online

Extract

The complication rates of emergent airway management in the adult ICU are reported to be as high as 54%, which is substantially higher than the incidence quoted for elective intubations in the operating room, and is largely due to the limited cardiopulmonary reserve of critically ill patients in the setting of multiple organ dysfunction.1 Furthermore, the incidence of encountering a difficult airway in the emergent setting is almost twice as high as in an elective scenario.2-7 Although several predictors of difficult intubation (DI) and ventilation have been validated in patients undergoing elective airway management (Mallampati classification, Patil test, LEMON-law [mnemonic for look externally, evaluate the 3-3-2 rule, Mallampati score, presence of obstruction, and neck mobility])8-10 the situation encountered by the health-care team in the ICU during airway emergencies often precludes the proper assessment of risk factors for DI and difficult ventilation. In addition, as opposed to elective intubations in the operating room, the return to spontaneous breathing if attempts at emergency endotracheal intubation (EEI) fail often is impossible once hypnotic drugs are administered. The most frequent complications encountered during EEI in critically ill patients are shown in Figure 1 and Table 1. It is important to note that complication rates increase with two or more attempts at intubation,4 and if complications during emergent airway management occur in the ICU, they are more frequently life threatening (50%) than complications occurring in the operating room (12%) according to the 4th National Audit Project performed in the United Kingdom.14,15 In a prospective observational study, Jaber and colleagues11 demonstrated that patients in the ICU who experienced complications during emergent airway management had a mortality rate that was twice as high as those who were intubated without complications (61% vs 31%, respectively).

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543