ICU SAQs · Airway management
RSI of a hypoxaemic, hypotensive patient
A CICM Second-Part SAQ on the conduct of RSI in the physiologically difficult airway — preoxygenation, cardiovascular resuscitation, dose reduction in shock, and the team, equipment and monitoring that prevent the cardiovascular collapse and hypoxaemia that complicate nearly half of ICU intubations.
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Prompt
A 68-year-old man with pneumonia and septic shock (blood pressure 86/48 mmHg on noradrenaline, SpO2 88% on a non-rebreather mask) requires intubation. Describe your preparation and the conduct of rapid sequence induction that minimises the risk of peri-intubation harm.
Question
A 68-year-old man with pneumonia and septic shock — blood pressure 86/48 mmHg on a noradrenaline infusion, heart rate 118/min, SpO2 88% on a non-rebreather mask — requires endotracheal intubation for respiratory failure. Describe your preparation and the conduct of rapid sequence induction that minimises the risk of peri-intubation harm. (10 marks)[1]
[2]References4ShowHide
- [1]Russotto V, Myatra SN, Laffey JG, et al. Intubation Practices and Adverse Peri-Intubation Events in Critically Ill Patients From 29 Countries. JAMA, 2021.PMID 33755076
- [2]Guitton C, Ehrmann S, Volteau C, et al. Nasal High-Flow Preoxygenation for Endotracheal Intubation in the Critically Ill Patient: A Randomized Clinical Trial. Intensive Care Medicine, 2019.PMID 30666367
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [4]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.