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INTRODUCTION

Airway management can significantly affect outcomes for hospitalized critically ill patients. Failure to deliver adequate oxygen may cause irreversible brain damage or preclude successful resuscitation. Options for management may range from assisted ventilation with a bag-valve-mask (BVM) to noninvasive ventilation (NIV) support to endotracheal intubation (Table 121-1). A successful outcome in any intubation demands proficiency in patient assessment, knowledge of the equipment (basic and advanced), requisite technical skills, appreciation of individual limitations, and an alternative plan to deal with the difficult or failed airway.

Table 121-1Overview of Emergency Airway Management

A small survey published in 2010 noted that individual hospitalists (n = 175) performed, on average, only 10 endotracheal intubations in the previous year with a range of 3 to 20. For those performing endotracheal intubation, it is important to maintain this essential skill, and to be aware of their own practices and skill limitations. Depending on their clinical environment and work setting, the expectations for different hospitalists in advanced airway management will vary. However, all hospitalists should be versed in initial airway management and stabilization, including effective use of oral and nasal airway and BVM devices.

Successful intubation requires not only knowledge of the basic procedural steps, but also knowledge of airway anatomy, landmarks, and locations of various airway structures relative to each other.

INDICATION FOR INTUBATION

All indications for endotracheal intubation can be classified as (1) failure to maintain a patent airway, (2) failure of oxygenation and/or ventilation, and (3) anticipation of a rapidly deteriorating clinical course (Table 121-2).

TABLE 121-2Indications for Intubation

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