Airway Management in Critical Care - New Guidelines, Old Problems

Abstract

Intensive care training in the UK is undergoing change. Traditionally, the majority of intensive care medicine (ICM) clinicians were from an anaesthetic background with trainees and consultants receiving specific training and experience in basic and advanced airway management. As ICM becomes a stand-alone specialty with intake of trainees from other acute medical backgrounds, these airway skills can no longer be taken for granted. Advanced ICM trainees require only six months of training in anaesthesia, which could mean that the management of the difficult airway from intubation through to successful extubation will become increasingly challenging for those without advanced airway skills. The recent Royal College of Anaesthetists NAP4 audit aimed to identify and study major complications of airway management in the UK. It described many of these events as likely to have been avoidable, with a disproportionately high number of adverse airway incidents occurring in the intensive care unit (ICU) and emergency department. 1 When compared with ‘anaesthetic’ airway incidents, ICU airway events were more likely to be managed by doctors with less airway experience, occur out of hours and lead to more frequent permanent harm and death. Similar findings are echoed in the report written on behalf of the UK National Patient Safety Agency. 2