Airway equipment on the intensive care unit for management of the unanticipated difficult intubation

Introduction

This study was designed to assess the ability of ICUs to deal with the unanticipated difficult intubation. The ICU is a location in which the incidence of difficult intubation has been found to be significantly higher than in theatre (8–22.5% vs 1.5%).

Method

We contacted all adult general ICUs in the South of England and invited the physician responsible for airway management to take part in a structured interview. The interview was designed to follow the Difficult Airway Society (DAS) guidelines. We designed six equipment-related questions that identified a unit as achieving the minimum levels of equipment necessary. These included availability of laryngoscopes, capnography, LMA/ILMA, and rescue techniques.

Results

Forty-five of 51 units responded (88%). Mandatory equipment levels are shown in Figure 1.

Figure 1

Airway equipment available on ICUs. A score of 6/6 is considered the minimum.

Discussion

Difficult intubation is more likely on the ICU, yet only 20% of units keep sufficient equipment immediately available. The most serious omissions were the 29% of units without a rescue technique immediately available and the one-third of units not routinely employing capnography.