Intubation in the ICU: We Could Improve our Practice

Abstract

Airway management is a commonly performed procedure in the intensive care unit (ICU). Hypoxemia and cardiovascular collapse represent the initial and most serious life-threatening complications associated with difficult airway access, both in emergency intubation in the critically ill [1–4] and in planned intubations (e. g., scheduled surgery or invasive procedures) [5]. To prevent and limit the incidence of life-threatening complications following intubation, several pre-oxygenation techniques and intubation algorithms have been entertained.

The objectives of the present chapter are to:

• 1) describe new tools (e. g., the MACOCHA Score) to better identify patients at high-risk of difficult intubation and related complications;

• 2) describe new strategies for improving pre-oxygenation before intubation (e. g., continuous positive airway pressure [CPAP] or non-invasive ventilation [NIV]);

• 3) propose an intubation bundle (the Montpellier-ICU intubation algorithm) to limit complications related to the intubation procedure;

• 4) report recent data on the role of videolaryngoscopes in the ICU; and, finally,

• 5) propose an algorithm for secure airway management in the ICU (The Montpellier-airway ICU algorithm).