Intubation

Tracheal intubation (TI) is commonly performed in the setting of respiratory failure and shock, and is one of the most commonly performed procedures in the intensive care unit (ICU). It is an essential life-saving intervention; however, complications during airway management in such patients may precipitate a crisis. Hence, professional competence in airway management is required while caring for critically ill patients.

Airway management in the ICU differs significantly from TI carried out for routine surgical procedures in the operating rooms (OR). In the OR, elective intubations are performed on stable patients with good physiological reserve by skilled anaesthesiologists, and TI is associated with very low rates of complications. These observations are in stark contrast to the high occurrence of failed airways and major complications like severe hypoxaemia and cardiac arrest related to airway instrumentation in the ICU.[1–5] TI in the ICU is often performed in a high-pressure environment by junior medical staff, some of whom have had little or no training in airway management. In addition, complications in the critically ill patients are attributable to the compromised physiologic status of the patient, time constraints for evaluation of airway and inefficiency of conventional pre-oxygenation. Furthermore, many of the medications used to facilitate TI have adverse haemodynamic consequences.