The Physiologically Difficult Airway

• Main Authors: Jarrod M. Mosier, Raj Joshi, Cameron Hypes, Garrett Pacheco, Terence Valenzuela, John C. Sakles
• Format: Article
• Language: English
• Published: eScholarship Publishing, University of California 2015-12-01
• Series: Western Journal of Emergency Medicine
• Subjects: Acute respiratory failure; intubation; hypercapnea; hypoxemia; metabolic acidosis; mechanical ventilation; right ventricular failure; airway management
• Online Access: http://escholarship.org/uc/item/9kv5q8jg

Airway management in critically ill patients involves the identification and management of the potentially difficult airway in order to avoid untoward complications. This focus on difficult airway management has traditionally referred to identifying anatomic characteristics of the patient that make either visualizing the glottic opening or placement of the tracheal tube through the vocal cords difficult. This paper will describe the physiologically difficult airway, in which physiologic derangements of the patient increase the risk of cardiovascular collapse from airway management. The four physiologically difficult airways described include hypoxemia, hypotension, severe metabolic acidosis, and right ventricular failure. The emergency physician should account for these physiologic derangements with airway management in critically ill patients regardless of the predicted anatomic difficulty of the intubation.