The physiologically difficult airway: An emerging concept

Sheila Nainan Myatra, Jigeeshu Vasishtha Divatia, David J. Brewster

Research output: Contribution to journalReview ArticleOtherpeer-review

17 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)115-121
Number of pages7
JournalCurrent Opinion in Anaesthesiology
Issue number2
Publication statusPublished - Apr 2022


  • airway in the obese
  • airway management in ICU
  • airway management in the critically ill
  • difficult airway
  • obstetric airway
  • pediatric airway

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