Airway management in critically ill neurological patients

Respiratory complications play an important part in the morbidity and mortality of critically ill neurological patients. Assurance of airway patency is of primary concern in such patients. A plethora of airway maintenance techniques and devices have been recommended for securing and maintaining the airway. But, translaryngeal intubation through the oral route is the safest and most preferred technique. Proper assessment and adequate preparation of the patient before intubation helps to avert crises. In difficult intubation one may secure and maintain the airway by placing a laryngeal mask airway (LMA). The role of early tracheotomy in patients who require prolonged ventilatory support can not be overemphasized. However, the development of inert and softer endotracheal tubes with low pressure cuff has reduced the complications associated with endotracheal intubation. Finally and most importantly the best place to acquire competence in securing the airway is the operation theater not the intensive care unit.