Strategies to improve first attempt success at intubation in critically ill patients

Br J Anaesth. 2016 Sep:117 Suppl 1:i60-i68. doi: 10.1093/bja/aew061. Epub 2016 May 24.


Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient's tolerance for repeated or prolonged attempts at laryngoscopy and, as a result, hypoxaemia and haemodynamic deterioration are common complications. Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the 'difficult airway' in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.

Keywords: airway management; critical care; emergency department; emergency medicine; intensive care; intubation; laryngoscopy; prehospital.

Publication types

  • Review

MeSH terms

  • Airway Management / adverse effects
  • Airway Management / methods*
  • Airway Management / standards
  • Anesthesia, General / methods
  • Clinical Competence
  • Critical Care / methods*
  • Critical Illness / therapy*
  • Emergencies
  • Humans
  • Hypotension / etiology
  • Hypotension / prevention & control
  • Intubation, Intratracheal / adverse effects
  • Intubation, Intratracheal / methods
  • Intubation, Intratracheal / standards
  • Oxygen Inhalation Therapy / methods