TY - JOUR
T1 - The physiologically difficult airway
T2 - An emerging concept
AU - Myatra, Sheila Nainan
AU - Divatia, Jigeeshu Vasishtha
AU - Brewster, David J.
N1 - Funding Information:
This review provides new insights form the recent literature related to the use of noninvasive respiratory support to prevent tracheal intubation, improve the safety of tracheal intubation, and provide support following extubation in critically ill patients, to improve patient care.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/4
Y1 - 2022/4
N2 - Purpose of reviewThe physiologically difficult airway is one in which physiologic alterations in the patient increase the risk for cardiorespiratory and other complications during tracheal intubation and transition to positive pressure ventilation. This review will summarize the recent literature around the emerging concept of the physiologically difficult airway, describe its relevance and various patient types in which this entity is observed.Recent findingsPhysiologic derangements during airway management occur due acute illness, pre-existing disease, effects of anesthetic agents, and positive pressure ventilation. These derangements are especially recognized in critically ill patients, but can also occur in otherwise healthy patients including obese, pregnant and pediatric patients who have certain physiological alterations. Critically ill patients may have a physiologically difficult airway due to the presence of acute respiratory failure, hypoxemia, hypotension, severe metabolic acidosis, right ventricular failure, intracranial hypertension, and risk of aspiration of gastric contents during tracheal intubation.SummaryUnderstanding the physiological alterations and the risks involved in patients with a physiologically difficult airway is necessary to optimize the physiology and adopt strategies to avoid complications during tracheal intubation. Further research will help us better understand the optimal strategies to improve outcomes in these patients.
AB - Purpose of reviewThe physiologically difficult airway is one in which physiologic alterations in the patient increase the risk for cardiorespiratory and other complications during tracheal intubation and transition to positive pressure ventilation. This review will summarize the recent literature around the emerging concept of the physiologically difficult airway, describe its relevance and various patient types in which this entity is observed.Recent findingsPhysiologic derangements during airway management occur due acute illness, pre-existing disease, effects of anesthetic agents, and positive pressure ventilation. These derangements are especially recognized in critically ill patients, but can also occur in otherwise healthy patients including obese, pregnant and pediatric patients who have certain physiological alterations. Critically ill patients may have a physiologically difficult airway due to the presence of acute respiratory failure, hypoxemia, hypotension, severe metabolic acidosis, right ventricular failure, intracranial hypertension, and risk of aspiration of gastric contents during tracheal intubation.SummaryUnderstanding the physiological alterations and the risks involved in patients with a physiologically difficult airway is necessary to optimize the physiology and adopt strategies to avoid complications during tracheal intubation. Further research will help us better understand the optimal strategies to improve outcomes in these patients.
KW - airway in the obese
KW - airway management in ICU
KW - airway management in the critically ill
KW - difficult airway
KW - obstetric airway
KW - pediatric airway
UR - http://www.scopus.com/inward/record.url?scp=85125964148&partnerID=8YFLogxK
U2 - 10.1097/ACO.0000000000001102
DO - 10.1097/ACO.0000000000001102
M3 - Review Article
C2 - 35165233
AN - SCOPUS:85125964148
SN - 0952-7907
VL - 35
SP - 115
EP - 121
JO - Current Opinion in Anaesthesiology
JF - Current Opinion in Anaesthesiology
IS - 2
ER -