Critical Care Time 59. Airway Controversies with Dr. Jarrod Mosier, MD
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Sep 22, 2025 Dr. Jarrod Mosier, an emergency medicine-trained intensivist and ECMO director, dives into airway controversies and best practices. He discusses the importance of effective pre-oxygenation techniques, weighing the pros and cons of induction agents like etomidate and ketamine. The conversation touches on the advantages of video laryngoscopy and strategies for awake intubation. Mosier also makes a compelling case for supraglottic airways during cardiac arrest, explaining how these choices can significantly impact patient outcomes.
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Pre-Oxygenation Is Three-Part Physics
- Pre-oxygenation must build FRC, fill it with oxygen, and have a tolerable shunt fraction.
- Noninvasive support (BiPAP/high-flow) and tight circuits best achieve those goals in many ICU patients.
Don't Remove Oxygen Before Apnea
- Keep the oxygen source on until the patient is fully apneic to avoid re-nitrogenation and loss of denitrogenation gains.
- Use mask ventilation or apneic oxygenation continuously until ready to laryngoscope.
Pick One: BiPAP Often Works Best
- If you must pick a single pre-oxygenation method for RSI, consider BiPAP because it both recruits lung and denitrogenates.
- If the patient is already on high-flow, keep them there rather than switching to BiPAP before induction.