Airway Management

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Target exams

Red flags

• Peri-intubation cardiovascular collapse is the commonest major complication (42.6% in INTUBE) and the most lethal — resuscitate first: correct hypovolaemia, start or increase vasopressors, and reduce or avoid the induction dose before you push the induction agent. A patient intubated in uncorrected shock arrests on the syringe
• A low preoxygenation reserve means rapid desaturation — the critically ill patient desaturates within one or two minutes, not the eight minutes of a fasted healthy adult. Preoxygenate to an SpO2 of 100% where possible and use apnoeic oxygenation; never begin laryngoscopy on a patient who is already hypoxaemic
• Capnography is mandatory — the misplaced tube remains a leading cause of airway death (NAP4). Confirm tracheal placement with a sustained waveform of exhaled carbon dioxide on every intubation, not by chest movement or condensation alone
• A MACOCHA score of 3 or above predicts difficult intubation (validation NPV 98%) — assess every ICU patient before induction, prepare the difficult-airway kit, and call senior help early rather than after the first attempt fails
• Cannot intubate, cannot oxygenate is a time-critical emergency — if face-mask ventilation and a supraglottic airway both fail and oxygenation is being lost, perform emergency front-of-neck access (scalpel-bougie cricothyroidotomy) without delay; repeated fruitless attempts kill the patient