Title : Tracheal Intubation in Critically ill Adults. The 2018 National Airway Guideline from the Difficult Airway Society, Intensive Care Society, Faculty of Intensive
The 4th National Audit Project of the Royal College of Anaesthetists assessed major complications arising from airway management in the UK over a 12 month period and demonstrated that tracheal intubation in the ICU and Emergency Department was associated with exceptionally high levels of death and significant morbidity, compared to that in the OR. This is mirrored by experience throughout the world.
In response to this, the Difficult Airway Society and Royal College, together with the 2 UK Intensive Care steak-holders (Intensive Care Society & Faculty of Intensive Care Medicine) commissioned a guideline to address this problem.
This Working Party studied this issue for just over 3 years and published the guideline in January 2018.
The reasons for this high rate of complications are discussed and a systematic approach to avoiding these are covered.
It includes assessment of the airway and the implications for potentially complicated airway management, optimal use of newer technologies like video-laryngoscopy and best practice for maintaining oxygenation during the intubation attempt.
Human Factors are a major element in minimising death and other serious complications, and this is addressed in detail.
A new intubation algorithm was developed which includes elements of the Vortex Approach, together with how best to acutely rescue difficult or failing airway management in critically ill adults.
Optimal techniques for emergency surgical access to the airway are also covered.
The specific areas of tracheal intubation in the critically ill obese patient is described, together with burns and those with potential cervical spinal trauma.
This has been very well received and adopted as the standard in 20 countries in Latin America.