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 GUIDELINES
Year : 2017  |  Volume : 21  |  Issue : 3  |  Page : 146--153

Republication: All India difficult airway association 2016 guidelines for tracheal intubation in the intensive care unit


1 Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 Department of Anaesthesiology and Critical Care, J N Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India
3 Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
4 Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
5 Department of Anaesthesiology, Kasturba Medical College, Manipal, India
6 Kailash Cancer Hospital and Research Centre, Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, India
7 Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
8 Department of Anaesthesiology, Critical Care and Pain, All India Institute of Medical Sciences, New  Delhi, India
9 Department of Paediatric Anaesthesia, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India
10 Department of Anaesthesiology, North Bengal Medical College, Darjeeling, West Bengal, India

Correspondence Address:
Jigeeshu Vasishtha Divatia
Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai  -  400  012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijccm.IJCCM_57_17

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Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often lifesaving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with under evaluation of the airway and suboptimal response to preoxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; Wherever, robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the (AIDAA) and Indian Society of Anaesthesiologists. Noninvasive positive pressure ventilation for preoxygenation provides adequate oxygen stores during TI for patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnea before hypoxemia sets in. High flow nasal cannula oxygenation at 60–70 L/min may also increase safety during intubation of critically ill patients. Stable hemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.






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