The Difficult Airway: Advances in Understanding

Abstract

Airway management is a common procedure in patients undergoing anaesthesia and in the critically ill requiring invasive mechanical ventilation. It is usually an uncomplicated and safe intervention, but difficulties can arise due to anatomic airway abnormalities. Videolaryngoscopy may improve patient outcomes when compared with direct laryngoscopy in the anatomically difficult airway, including improved first-pass success at tracheal intubation, reduced difficult laryngeal views, reduced oxygen desaturation, reduced airway trauma, and improved recognition of oesophageal intubation. The ‘physiologically difficult’ airway is one where the clinical condition of the patient is such that they are predisposed to hypoxia and/or cardiovascular collapse during the intubation procedure. Recent studies demonstrate a particularly high incidence of morbidity and mortality associated with airway management in the critically ill. 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 talk, the relevant literature on the approach to endotracheal intubation in the critically ill is reviewed. We discuss provide pragmatic approaches to performing intubations in patients who are physiologically unstable.

About the speaker

John Laffey is Professor of Anesthesia and Critical Care Medicine at the University of Galway, Ireland. He is Director of Clinical Research at University of Galway and the Saolta University Hospital Group, and the director of the Lung Biology research group at the University of Galway. Past roles include Chair of the Irish Critical Care Trials Group, and Section Chair of the Translational Biology Section at the European Society of Intensive Care Medicine.
His research is focused on ARDS and sepsis, particularly the mechanisms underlying lung and systemic organ injury. He has a longstanding interest in the investigation of the mechanisms of action and therapeutic potential of cell therapies for critical illnesses. Other interests include the epidemiology of ARDS and weaning from mechanical ventilation. He has extensive experience of early phase and later phase clinical trials.