How to Reduce the Most Common Airway Management Complications

Benn Horrisberger

Publish Date:

December 15, 2022

Intensive Care Unit (ICU) and Emergency Department (ED) physicians are well-trained to intubate patients whenever it is clinically indicated. Some of the most common indications of endotracheal intubation are to protect the central airway, provide mechanical support for ventilation in airway emergencies, administer general anesthesia, manage acute respiratory failure, and more. 

While endotracheal intubations are standard procedures that play an essential role in the care of critically ill and injured patients, the risk of potential complications is real. Although serious adverse outcomes are rare, they cannot be underestimated. Tragically, most airway complications are unanticipated, particularly in the ICU and ED. Therefore, to reduce complications related to airway management - and specifically to endotracheal intubations - doctors and hospitals must establish optimal airway management strategies and strive to achieve successful intubation. 

Most Common Airway Management Complications 

When physicians attempt to insert an endotracheal tube into the airway of patients, complications can occur during or immediately following the procedure. Such complications can be classified as early or late, depending on the time of symptom onset. The third category of complications includes those that arise due to prolonged intubation. 

Early Complications 

Early complications can occur at any stage of the endotracheal tube insertion, resulting in devastating, potentially life-long consequences. Examples of these are:

  • Prolonged voice hoarseness
  • Arytenoid dislocation
  • Cervical spine and spinal cord injuries
  • Traumatic dental injury

Late Complications

Late-onset complications arise days to weeks after extubation and often result from prolonged intubations. Examples are: 

  • Obstructive fibrinous tracheal pseudomembrane formation (an uncommon complication of endotracheal intubation that can result in failure of extubation)
  • Post-intubation tracheal stenosis (a narrowing of the trachea following prolonged intubation)
  • Laryngeal stenosis (a narrowing of the upper airway between the larynx and the trachea)
  • Tracheomalacia (partial collapse of the trachea)
  • Tracheoesophageal fistula (an abnormal connection in one or more places between the esophagus and the trachea) 
  • Tracheoarterial fistula (an unusual but devastating complication of tracheostomy)

Complications of Prolonged Intubation

Intubation is considered prolonged when its duration exceeds seven days. Studies have shown that prolonged intubation predisposes patients to complications that present while the patients are still on a mechanical ventilator or early at extubation. 

  • Pressure ulcer around adhesive tapes
  • Ventilator-associated pneumonia (VAP)
  • Sinusitis
  • Tracheomalacia 
  • Paralysis of the vocal cords
  • Laryngotracheal stenosis (an abnormal narrowing of the central air passageways)

Common Causes of Airway Management Complications

Multiple reasons can cause patients to incur complications as a result of intubations. One of the most common reasons is physicians fail to identify at-risk patients. Other potential causes are poor or inadequate planning and a lack of skilled staff or equipment to manage these events properly. 

Strategies to Reduce Complications Related to Airway Management

Several strategies exist to help prevent and reduce life-threatening complications associated with airway management. 

Follow Guidelines For Difficult Airway Management

Hospitals can take a step toward improving patient outcomes by ensuring physicians follow the established guidelines for managing difficult airways. For instance, anesthesiologists should be familiar with the American Society of Anesthesiologists "Practice Guidelines for Management of the Difficult Airway." 

These guidelines include guiding recommendations about airway evaluation, basic preparation for complex airway management, strategies for difficult airway intubation, extubation, and follow-up care. 

Discover Innovative Airway Devices

As difficult airways are inherently unanticipated, doctors must be prepared to effectively address them when they surface. When physicians possess the necessary skillset, expertise, various airway management techniques, and innovative tools, the risk of complications can be reduced significantly. 

Novel intubation devices, such as QuickSteer™ allow physicians to quickly and effectively intubate patients with even the most difficult airways and thereby reduce patient injury and improve first-pass success rates. With QuickSteer™, avoiding failed tracheal intubation attempts becomes a reality, helping reduce the risk of airway management-related complications. 


After implementing some of the recommendations above, it's essential to conduct regular audits at the ED and ICU to pinpoint airway management problems and events. Ensure physicians and staff are well trained and qualified to differentiate between situations where intubations are indicated and those that are not. In addition, developing and using intubation checklists can also be beneficial. 

Watch this video to see QuickSteer™ in action. 

Want to learn more? Connect with a specialist by calling 763.330.2162 or emailing

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