Critical Care Time 11. The Physiologically Difficult Airway
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Nov 6, 2023 This episode of the podcast explores the physiologically difficult airway in critical care, discussing the differences between intubating in the OR vs. critically ill patients, comparing video laryngoscopy and direct laryngoscopy, the use of bicarbonate in acidosis, maximizing alveolar oxygen, the use of ketamine in traumatic brain injury, and the debate on rockuronium vs. succinylcholine for paralysis during intubation. The hosts also discuss specific physiological considerations in challenging cases.
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Complex vs. Difficult Airway
- A "difficult" airway implies operator error, while "complex" acknowledges situational challenges.
- Patient factors, operator skill, team dynamics, and the environment all contribute to airway complexity.
Physiological vs. Anatomical Difficulty
- Anticipating a physiologically difficult airway is harder than an anatomically difficult one due to dynamic internal factors.
- External clues for physiological difficulty are often subtle, unlike anatomical difficulties with clear indicators.
OR vs. ICU Intubations
- Cyrus Askin contrasts OR intubations with ICU intubations, likening them to commercial versus military aviation.
- ICU intubations demand adaptability and resilience in an uncontrolled environment.