[Airway devices in the intensive care unit]

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Anesthesiology

Context:

• Intensive care units (ICUs) require precise airway management strategies.
• Noninvasive ventilation (NIV) is crucial for acute respiratory failure but faces challenges like mask intolerance.
• Difficult airway scenarios and the need for long-term mechanical ventilation necessitate specific device choices.

Purpose:

• To review and delineate the indications for various airway devices used in the ICU.
• To highlight the importance of mask selection in NIV to improve patient tolerance and treatment efficacy.
• To compare different airway management techniques, from NIV to endotracheal intubation and tracheostomy.

Summary:

• NIV for acute respiratory failure primarily utilizes full-face masks, with total face masks and helmets as viable alternatives; nasal masks and mouthpieces are less common in ICUs.
• Extraglottic devices and coniotomy are reserved for managing difficult airway situations.
• Endotracheal intubation is standard but carries risks, while tracheostomy is preferred for prolonged mechanical ventilation.

Impact:

• Informing clinical decisions for optimal airway device selection in diverse ICU patient populations.
• Improving patient outcomes by addressing NIV challenges and selecting appropriate ventilation strategies.
• Providing a comprehensive overview to guide healthcare professionals in complex airway management scenarios.