Primary Goals of Clinicians when Managing Challenging Airways

Benn Horrisberger

Publish Date:

January 11, 2023

Ask any ED or operating room (OR) clinician about difficult airway management. They will likely tell you that the situation can quickly become a nightmare for even the most experienced anesthesiologist. But why do these frequently performed life-saving procedures represent such a challenge? And what are the primary objectives of physicians when intubating patients with challenging airways? We have the answers to both of these questions. So keep reading. 

Difficult Or Failed Intubations Can Have Severe Consequences

According to a study published in JAMA Network, physicians perform approximately 15 million endotracheal intubations (ETIs) in operating rooms annually in the US. In addition, another 650,000 intubations occur in hospitals outside the ORs, including 346,000 in emergency departments. Based on the significant number of procedures performed, one may think intubations must be relatively low-risk. But in reality, the rate of complications is high, including the potential for dental, larynx, and other soft tissue damage, hemodynamic instability, respiratory complications, and cardiac arrest.

In straightforward cases, physicians with the proper training and experience are expected to intubate patients without complications. However, challenging or complex airway cases - especially unexpected ones - may require specific techniques used less frequently or access to a team of medical professionals with special skills and devices. Further complicating matters is that even specialists have difficulty accurately predicting which patients will present with challenging airways. In fact, according to some studies, more than 90 percent of difficult airways are unanticipated. 

What Do Physicians Aim For When Managing Difficult Airways?

Considering the challenge of difficult airway management and the severe consequences of failed intubations, we wanted to determine clinicians' primary goals when managing challenging airways. To understand clinician perception of intubation challenges and risks, we surveyed 251 medical professionals, including 103 anesthesiologists, 50 emergency room doctors, 96 Certified Nurse Anesthetists, and 2 advanced registered nurse practitioners in critical care. 

We found that almost 50 percent of respondents encountered challenging airways in 5 percent or more of airway cases, with 22 percent estimating their frequency at 10 percent. In addition, about a third of the respondents admitted to only predicting difficult intubations less than 75 percent of the time. Their primary goals in such cases focus on securing airway control and ensuring they plan ahead of time with the right equipment at hand.

Our survey also revealed that over 90 percent of clinicians consider oxygen desaturation the most significant risk. In addition, 70 percent of respondents said visualization problems caused the main difficulty, followed by navigation challenges, which were mentioned by 20 percent. 

Open-ended responses confirmed that physicians are primarily concerned with securing airway control and want to plan for difficult airways. 

Secure Airway Access: 

'My goal is successful control of the airway with an endotracheal tube."

"Oxygenate and ventilate. Control the situation as much as possible and have a smooth approach since the first attempt is the best attempt."

"Gain a patent airway as quickly as possible with minimal to no harm to the patient."

"I intend to secure the airway as safely as possible while minimizing harm to the patient, utilizing the latest technologies and pharmacologic agents." 

"To stay calm and know I have the proper tools at hand."

Plan Ahead

"Prepare before a disaster. Have all the difficult intubation supplies at bedside." 

"Devising Plan A (and a Plan B) before intubation that minimizes attempts, airway trauma, and patient discomfort."

"Ensure first attempt success if identified beforehand. If encountered unexpectedly, achieve success with minimal attempts by calling for help early and utilizing appropriate resources."

"Have backup plans, hands, and equipment READILY AVAILABLE BEFORE starting. Know your anatomy before starting. If a difficult airway is suspected, make sure a dedicated person is readily available."

"My goal is always first past success. However, in the setting of multiple attempts, my goal is to maintain adequate oxygenation and ventilation at all times so that troubleshooting can take place."


No physician wants to lose a patient due to the inability to secure airway control quickly and successfully, even in the most challenging airway cases. This is why Access Airways invented QuickSteer- the latest innovation in airway management. QuickSteer's single-hand operation enables physicians of all experience levels to navigate the airway they can visualize but not get to with today's alternative tools. 

Watch this video to see QuickSteer™ in action. 

Ready to learn more? Connect with a customer service team member by calling 763.330.2162 or emailing

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