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The physiologically difficult airway: an emerging concept.

Sheila Nainan Myatra1, Jigeeshu Vasishtha Divatia1, David J Brewster2

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Summary

The physiologically difficult airway presents unique intubation challenges due to patient-specific alterations. Recognizing these risks is crucial for optimizing patient physiology and preventing complications during ventilation.

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Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Airway Management

Background:

  • The physiologically difficult airway involves patient-specific alterations increasing risks during tracheal intubation and positive pressure ventilation.
  • These challenges are observed in critically ill patients and can also affect seemingly healthy individuals like the obese, pregnant, or pediatric populations.

Purpose of the Study:

  • To review recent literature on the concept of the physiologically difficult airway.
  • To describe its relevance and identify patient types exhibiting this condition.

Main Methods:

  • Literature review summarizing current understanding of the physiologically difficult airway.
  • Analysis of patient populations and physiological derangements associated with difficult airways.

Main Results:

  • Physiologic derangements arise from acute illness, pre-existing conditions, anesthetic agents, and positive pressure ventilation.
  • Critically ill patients may experience respiratory failure, hypoxemia, hypotension, acidosis, right ventricular failure, intracranial hypertension, and aspiration risk.
  • Obese, pregnant, and pediatric patients can also present with a physiologically difficult airway.

Conclusions:

  • Understanding physiological alterations is key to optimizing patient management during intubation.
  • Strategies to mitigate risks and avoid complications in physiologically difficult airways require further research.
  • Improving outcomes for these patients necessitates a focus on physiological optimization and tailored approaches.