**Step 3: Perform extubation:**


#### **Step 4: post-extubation care:**


#### **2.4 Special circumstances**


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**4. Conclusion**

*Airway Management in Critical Settings DOI: http://dx.doi.org/10.5772/intechopen.93923*

details.

discussed earlier must be considered.

be available in specific chapter.

**3. Training and skills maintenance**

4.ETT exchange in ICU remains common for many reasons that happening frequently such as ETT displacement or occlusion by crusted mucus, cuff rupture or surgical procedures mandate other ETT type. This task has to be taken seriously and reviewing the initial ETI documentation is essential and will provide a logical ETT exchange plan. Tube-exchange catheter is designed for that, providing its use with DL or VL which has superior glottic view, greater success rate and fewer complications [53]. New ETI could be another alternative but with the previous ETI documentation, all precautions and recommendations

5.Varieties of abnormal clinical status might be accompanying the airway management in critically ill patients such as obesity, burn, pregnancy etc.… and required specific considerations, please review the book chapters for more

6.Specific alteration in airway management in COVID19 might be considered despite few data available. High Flow Nasal Cannula (HFNC) suggested to reduce the requiring supported ventilation [54] and NIV might reduce the rate of tracheal intubation [55]. Tracheal intubation in COVID 19 patients is considered as highest risk for health care professionals cross-infection and could be carried out in controlled environment [56]. More details about this topic will

Critically ill patients usually are underestimated as specific airway difficulty and being at high risk of failure. Not only due to infrequent training of focused airway and crisis management but also, physicians may neither have anesthesia rotation nor airway skills required for difficult airway management. Training on sole skills performance is unsatisfactory to achieve maximum safety [57] and ineffective teamwork that includes poor communication, lack of shared targets, situational awareness, role assignment, leadership, coordination, mutual respect and post-

Focused risk assessment training, prevention of hypoxia, airway red flags, early call for help and request for advanced airway skills in concomitant with specific protocols and guideline presented. Team training, focused airway management training courses and workshops including simulation-based education are crucial

The crisis resource management (CRM) techniques from aviation industry has been advocated for use in ICU to promote a team approach to patient care and safety in critical settings [59]. The committee on quality of healthcare in America believes that health care organization should accomplished team training programs for health care professionals in critical care areas using demonstrating message such as crew resources management techniques employed in aviation, including simulation

Airway management in critically ill patient continues to be challenging for health care professionals even for expertise requiring implementation of specific guidelines and protocols to eliminate the its adverse consequences. Airway management tools

event debriefings is associated with poor patients' outcome [58].

and step up for airway management in both ED and ICU suites.

as people make fewer errors when they work in teams [60].

*Special Considerations in Human Airway Management*

available for use.

**Step 2: Prepare the extubation:**

success of extubation.

discussed in preparation.

especially in obese patients.

**Step 4: post-extubation care:**

breathing and agitation.

**Step 3: Perform extubation:**

of 100% O2.

alternatives.

**2.4 Special circumstances**

other chapters.

iii.A difficult airway trolley equipment and monitors should be immediately

i.Target for optimization of airway and spontaneous ventilation to ensure the

ii.This could be carried out by different methods such as ETT cuff leak test; to exclude laryngeal edema, spontaneously breathing trial (SBT), gastric decompression; as gastric distension results in diaphragmatic splint and breathing restriction. The plan for airway rescue must be considered and

i.Avoid interruption of oxygenation by pre-extubation oxygenation via FIO2

ii.Patient's position; without adequate supporting evidence any one over the other, it's advisable extubation in head-up or semi-recumbent position

awake state or conscious-sedation state using Remifentanil [52] might be

i.Beware of Warning signs of early airway compromise; stridor, obtunded

ii.Standard monitoring should be continued in post-extubation phase.

iv.Upright position, and high-flow humidified oxygen administration.

vi.Clinical details and instructions for extubation and post-extubation care should be recorded focusing on difficulties and details of airway manage-

1.Airway management for ICU procedures like bronchoscopy, please refer to

3.Previous tracheostomy that recently disconnected, it's advisable to re-cannulate

iii.Standard respiratory care for patients with airway compromise.

v.Documentation and recommendations for future management.

ment and future recommendations should be recorded.

2.Full stomach in ICU, will be discussed in another chapter.

the stoma but proceed for FONA should not be delayed [19].

iii.Gentle suctioning of oropharyngeal cavity and extubation in fully

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