Airway management issues in the intensive care unit: revisiting old paradigms and broadening our horizons

Airway management in the intensive care setting provides unique challenges that can be quite daunting, even for the most experienced practitioner. Airways are usually intubated for long periods, multiple comorbidities often interfere with "routine" airway management practices, and patients are often physiologically disadvantaged or hemodynamically unstable. Strapped with this calamity, the first responder to a patient with an acutely compromised airway is often someone less experienced with global airway management skills. As anesthesiologists, we are very familiar with the skill sets necessary to handle these predicaments, and as intensivists, we have the fortunate opportunity to share that wealth of information and experience. Airway care in the intensive care unit is a continuum-from elective or emergent intubation, to airway preservation and hygiene, to elective or unintentional extubation. Thus, familiarization with the basics of airway management in routine and "first responder" settings should bolster confidence and greatly improve patient safety and outcomes.