Strategies to improve first attempt success at intubation in critically ill patients

B. S. Natt, J. Malo, C. D. Hypes, J. C. Sakles, J. M. Mosier

Research output: Contribution to journalReview articlepeer-review

74 Scopus citations


Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient's tolerance for repeated or prolonged attempts at laryngoscopy and, as a result, hypoxaemia and haemodynamic deterioration are common complications. Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the 'difficult airway' in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.

Original languageEnglish (US)
Pages (from-to)i60-i68
JournalBritish Journal of Anaesthesia
StatePublished - Sep 1 2016


  • airway management
  • critical care
  • emergency department
  • emergency medicine
  • intensive care
  • intubation
  • laryngoscopy
  • prehospital

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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