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Editorials: Point/Counterpoint Editorials |

Counterpoint: Should an Anesthesiologist Be the Specialist of Choice in Managing the Difficult Airway in the ICU? Not NecessarilyAnesthesiologist for Airway in ICU? No

Kevin C. Doerschug, MD, FCCP
Author and Funding Information

From the Division of Pulmonary Diseases, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine.

Correspondence to: Kevin C. Doerschug, MD, FCCP, C33 General Hospital, Internal Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242; e-mail: kevin-doerschug@uiowa.edu


Financial/nonfinancial disclosures: The author has reported to CHEST the following conflicts of interest: Dr Doerschug is the program co-chair of the American College of Chest Physicians Airway Management Simulation Education Program.

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):1375-1377. doi:10.1378/chest.12-2196
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Extract

The premise of this debate lies in the fact that most board-certified critical care physicians are internists and not anesthesiologists. Furthermore, I assume that the implied question is, “Should a nonanesthesiology intensivist call an anesthesiologist (often not an intensivist) to intubate a critically ill patient?”

Complications occur frequently during ICU intubations. Anesthesiologists generally are viewed as the airway experts. Hence, this debate seems over before it begins. However, let us review the available data closely, and it will become evident that an anesthesiologist is not the clear solution to reduce complications during ICU intubations. Rather,

  • 1. Complications are common in critical illness, regardless of intubator;

  • 2. Intensivists and anesthesiologists each bring distinct skills to the bedside, and it is not clear which skill set is more important; and

  • 3. A structured approach that addresses the known risks of ICU intubations is more important than the medical specialty.

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