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Review ArticleNarrative Review

Approach to the Physiologically Challenging Endotracheal Intubation in the Intensive Care Unit

Andrew J Hickey, Matthew J Cummings, Briana Short, Daniel Brodie, Oliver Panzer, Purnema Madahar and Max R O’Donnell
Respiratory Care May 2023, respcare.10821; DOI: https://doi.org/10.4187/respcare.10821
Andrew J Hickey
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York.
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Matthew J Cummings
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York.
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Briana Short
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York.
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Daniel Brodie
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York.
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
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Oliver Panzer
Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York.
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Purnema Madahar
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York.
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Max R O’Donnell
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
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Abstract

Endotracheal intubation for airway management is a common procedure in the ICU. Intubation may be difficult due to anatomic airway abnormalities but also due to physiologic derangements that predispose patients to cardiovascular collapse during the procedure. Results of studies demonstrate a high incidence of morbidity and mortality associated with airway management in the ICU. To reduce the likelihood of complications, medical teams must be well versed in the general principles of intubation and be prepared to manage physiologic derangements while securing the airway. In this review, we present relevant literature on the approach to endotracheal intubation in the ICU and provide pragmatic recommendations relevant to medical teams performing intubations in patients who are physiologically unstable.

  • endotracheal intubation
  • intensive care unit
  • physiologically difficult airway

Footnotes

  • Correspondence: Max R. O’Donnell MD, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH-8-East Room 101, New York, NY 10032. E-mail: mo2130{at}cumc.columbia.edu
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Respiratory Care: 68 (6)
Respiratory Care
Vol. 68, Issue 6
1 Jun 2023
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Approach to the Physiologically Challenging Endotracheal Intubation in the Intensive Care Unit
Andrew J Hickey, Matthew J Cummings, Briana Short, Daniel Brodie, Oliver Panzer, Purnema Madahar, Max R O’Donnell
Respiratory Care May 2023, respcare.10821; DOI: 10.4187/respcare.10821

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Approach to the Physiologically Challenging Endotracheal Intubation in the Intensive Care Unit
Andrew J Hickey, Matthew J Cummings, Briana Short, Daniel Brodie, Oliver Panzer, Purnema Madahar, Max R O’Donnell
Respiratory Care May 2023, respcare.10821; DOI: 10.4187/respcare.10821
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Keywords

  • endotracheal intubation
  • intensive care unit
  • physiologically difficult airway

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