How
to improve intubation in the intensive care unit. Update on knowledge and
devices
De Jong, A., Myatra, S.N., Roca, O. et al.
Intensive Care Med 48, 1287–1298 (2022).
Tracheal intubation in the critically ill is associated with
serious complications, mainly cardiovascular collapse and severe hypoxemia. In
this narrative review, we present an update of interventions aiming to decrease
these complications. MACOCHA is a simple score that helps to identify patients
at risk of difficult intubation in the intensive care unit (ICU).
Preoxygenation combining the use of inspiratory support and positive
end-expiratory pressure should remain the standard method for preoxygenation of
hypoxemic patients. Apneic oxygenation using high-flow nasal oxygen may be
supplemented, to prevent further hypoxemia during tracheal intubation. Face
mask ventilation after rapid sequence induction may also be used to prevent
hypoxemia, in selected patients without high-risk of aspiration. Hemodynamic
optimization and management are essential before, during and after the
intubation procedure. All these elements can be integrated in a bundle. An
airway management algorithm should be adopted in each ICU and adapted to the
needs, situation and expertise of each operator. Videolaryngoscopes should be
used by experienced operators.
