Clinicians have many discussions about intubation and the predictors of difficult airways. But unfortunately, even the most experienced and skilled doctors struggle to accurately predict which patients will present with complex airways. Avoiding the potentially severe consequences of failing to secure a patient's airway is critical because it can result in airway-related complications, including aspiration of gastric contents, laryngospasm, bronchospasm, hypoxic brain injury, or death in minutes. 

 Early recognition of possible airway management difficulties is a game changer. When clinicians successfully predict which patients' airways may be challenging to manage, it allows them to plan accordingly, minimizing the chances of severe morbidity and ultimately improving patient outcomes. Similarly, formulating an airway management strategy for clinical situations when unanticipated difficult airways arise can also decrease adverse outcomes. 

What Is A Difficult Airway? 

 Multiple definitions of difficult airways exist in the clinical literature with variations between expert guidelines. According to the 2022 American Society of Anesthesiologists (ASA) Practice Guidelines for Management of the Difficult Airway, difficult airways include anticipated and unanticipated clinical situations where a physician trained in anesthesia care experiences difficulty or failure with one or more of the following:

• facemask ventilation
• laryngoscopy
• ventilation using a supraglottic airway
• tracheal intubation
• extubation
• invasive airway

National and international bodies, such as ASA and the Difficult Airways Society, offer a basic pathway for difficult intubation. They also stress the importance of clinicians attempting the procedure to be familiar with the necessary equipment and techniques for successful intubation, even in clinical situations involving unanticipated complex airways.

What Is Endotracheal Intubation, And Why Is It Performed?

Endotracheal intubation is a standard emergency procedure that doctors perform on unconscious patients or on those unable to breathe independently. The primary objectives of tracheal intubation are to open the airway, allow oxygen to travel to and from the lungs, and prevent suffocation. The procedure involves anesthesia and the insertion of a flexible plastic tube into the patient's trachea through the mouth.

The most common reasons patients undergo this procedure are:

• to open the airways to administer anesthesia, oxygen, or medication
• to help the patient breathe
• to protect the lungs
• to sedate a patient to allow recovery from a severe injury or illness

Regardless of the reason for the intubation, the procedure is invasive and comes with potentially serious risks. Even without encountering difficult airways, physicians may inadvertently inflict injury to teeth, dental work, the throat or trachea, or witness their patients experience lung complications or damage. Complex airways further complicate the procedure and increase the risks of severe morbidity and iatrogenic mortality. 

Solutions For The Challenges And Risks Of Difficult Intubation

Studies have confirmed that the vast majority - more than 90% - of difficult airways are unanticipated. To assess the predictors of difficult airway cases, doctors must consider multiple factors, including the patient's medical and surgical history and the clinical context necessitating the procedure.

The first step is to perform a thorough clinical evaluation of the airway to pinpoint potential difficulty. This assessment should take place as soon as the patient experiences respiratory distress. Doctors should identify any congenital or acquired anatomical defects that could potentially interfere with the safe insertion of the tube into the trachea. Trauma to the head, neck, or face, mouth-frothing, or oral bleeding are signs of possible difficulties. 

Another critical component of mitigating the challenges of difficult airway management is to make innovative technologies, such as QuickSteer™, part of your pathway for intubation. QuickSteer™ works equally well with direct and video laryngoscopes and facilitates the quick, safe, and effective intubation of patients with difficult airways by allowing physicians to control the stylet tip direction and placement. 

Thanks to QuickSteer™'s ease of use and single-hand operation, physicians of all experience levels can successfully intubate even the most difficult airways making the procedure quicker and safer. 

Watch this video to see QuickSteer™ in action. 

Want to learn more? Connect with a specialist by calling 763.330.2162 or emailing info@accessairways.com.

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References: 

https://www.ncbi.nlm.nih.gov/books/NBK470224/

https://www.bjanaesthesia.org/article/S0007-0912(20)30220-8/fulltext

https://pubs.asahq.org/anesthesiology/article/136/1/31/117915/2022-American-Society-of-Anesthesiologists