ICU SAQs · Airway management
The failed intubation — your structured response
A CICM Second-Part SAQ on the Difficult Airway Society 2015 algorithm for unanticipated difficult intubation — Plan A (optimised tracheal intubation), Plan B (supraglottic airway), Plan C (face-mask ventilation), Plan D (front-of-neck access) — the triggers to move between plans, the prediction of difficulty with MACOCHA, and the cardinal rule to declare difficulty early and call for help.
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Prompt
You are intubating a critically ill patient. After two optimal attempts you cannot visualise the cords or pass the tube, and the saturation is beginning to fall. Outline the structured approach to the difficult airway and the point at which you would change plan.
Question
You are intubating a critically ill patient. After two optimal attempts you cannot visualise the cords or pass the tube, and the oxygen saturation has begun to fall. Outline the structured approach to the unanticipated difficult airway and the points at which you would change plan. (10 marks)[1]
[1]References5ShowHide
- [1]Frerk C, Mitchell VS, McNarry AF, Mendonca C, et al. Difficult Airway Society 2015 Guidelines for Management of Unanticipated Difficult Intubation in Adults. British Journal of Anaesthesia, 2015.PMID 26556848
- [2]De Jong A, Molinari N, Terzi N, et al. Early Identification of Patients at Risk for Difficult Intubation in the Intensive Care Unit: Development and Validation of the MACOCHA Score in a Multicenter Cohort Study. American Journal of Respiratory and Critical Care Medicine, 2013.PMID 23348979
- [3]Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA, 2018.PMID 29800096
- [4]Cook TM, Woodall N, Frerk C; Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. British Journal of Anaesthesia, 2011.PMID 21447488
- [5]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.