Airway management of adults in the acute care setting

Airway management is an important skill for clinicians who care for adults who are acutely ill. Tracheal intubation can be life saving, but also carries a high rate of complications. Numerous tools are available to assess the difficulty of bag-valve-mask ventilation, intubation, and cricothyroidotomy; however, these tools currently have limited predictive value. Preparation, preoxygenation with non-invasive positive pressure ventilation, and physiological optimization are therefore essential steps to all airways. Drugs for induction and paralysis should be tailored to the patient. If rapid sequence intubation is performed, video laryngoscopy is preferred over direct laryngoscopy because it increases the likelihood of first pass success. Confirmation should include capnography or point-of-care ultrasound. Clinicians should ensure adequate analgesia and sedation to avoid patients experiencing awareness with paralysis, but this must be balanced with avoiding oversedation. This review summarizes the current data and provides an evidence based approach to airway management in the acute care setting.