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  • Print publication year: 2010
  • Online publication date: January 2011

Chapter 28 - Airway management in the ICU

from Section 3 - Specialties


Airway management is more difficult and stressful in obstetrics, and the consequences of difficulty are more serious than in many other areas. Most problems involve general anaesthesia although airway management may be required in regional anaesthesia. One advantage of regional anaesthesia, if not the main one, is the avoidance in most cases of the need for airway support. Apart from the possible contribution of reduced training in airway management and obstetric general anaesthesia, another factor that might lead to a higher reported incidence is that trainees are now taught to declare failure earlier rather than persist with attempts to intubate. The value of a drill in the management of difficult/failed intubation has long been recognised and a modern, simplified version is offered. Care must also be taken with tracheal extubation, especially if there is a risk of laryngeal oedema, perhaps exacerbated by intubation, for example in pre-eclampsia.

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Further reading

BuehnerU, OramJ, ElliotS, MallickA, BodenhamA. (2006). Bonfils semirigid endoscope for guidance during percutaneous tracheostomy. Anaesthesia, 61, 665–670.
GriffithsJ, BarberVS, MorganL, YoungJD. (2005). Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. British Medical Journal, 330, 1243.
GrilloHC. (2004). Anatomy of the Trachea. Surgery of the Trachea and Bronchi. Lewiston, NY: BC Decker.
GromannTW, BirkelbachO, HetzerR. (2009). Balloon dilatational tracheostomy: Initial experience with the Ciaglia Blue Dolphin method. Anesthesia and Analgesia, 108, 1862–1866.
Intensive Care Society, London. ICS Guidelines on ‘Standards for the Care of Adult Patients with a Temporary Tracheostomy.’ Available at:
KressJP, PohlmanAS, O'ConnorMF, HallJB. (2000). Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. New England Journal of Medicine, 342, 1471–1477.
LaveryGG, McCloskeyBV. (2008). The difficult airway in adult critical care. Critical Care Medicine, 36, 2163–2173.
MallickA, BodenhamA, ElliotS. (2008). An investigation into the length of standard tracheostomy tubes in critical care patients. Anaesthesia, 63, 302–306.
PawHGW, BodenhamAR. (2004). Percutaneous Tracheostomy: A Practical Handbook. Cambridge, UK: Cambridge University Press.
ReynoldsSF, HeffnerJ. (2005). Airway management of the critically ill patient. Chest, 127, 1397–1412.
SchwartzDE, MatthayM, CohenNH. (1995). Death and other complications of emergency airway management in critically ill adults: A prospective investigation of 297 tracheal intubations. Anesthesiology, 82, 367–376.
Tracman Trial. Available at:
WalzJM, ZayaruznyM, HeardSO. (2007). Airway management in critical illness. Chest, 131, 608–620.