*1.3.1 Spontaneous- breathing group*

Patients with breathing effort requiring O2 delivering device matched for their breathing power (**Table 1**).


#### **Table 1.**

*Oxygen delivery devices [3].*

#### **Figure 1.**

*Oxygen delivery devices (simple face mask with reservoir bag & nasal cannula).*

#### **Figure 2.** *Oxygen delivery devices (HAFOE).*

**85**

critically ill patients.

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

**2. Airway management in ICU**

stimulation or pharmacological agents used for it.

structured airway management for ICU staff.

In this group of critically ill patients, failure to maintain oxygenation and/ or ventilation despite an increase in FIO2 or development of apnea and indicated mechanical ventilation (MV), airway supporting device might be perpetual or temporary as a bridge till the steady one is fixed. Noninvasive positive pressure ventilation (NIPPV), could have both properties as it might be a tie till improvement or

and commonest O2 delivery device used in critically ill patients for oxygenation until an airway securing device fixed. It provides FIO2 close to 100% while the only O2 delivery device able to provide 100% FIO2 is the anesthetic breathing system.

Bag-mask with self-inflating reservoir bag; (**Figure 3**) is considered the simplest

Airway management in ICU is unlike that carried out in operation theater (OT) and higher in its complications; brain damage and death, and most of it is done on urgent and emergency basis in lack of experienced airway management professionals. In addition; critically ill patients showing limited cardiopulmonary reserve, this increases their risk of hypoxemia and hypotension upon exposure to airway management medications. Subsequently, tracheal intubation for those categories of patients could be life-threatening condition; up to 40% of patients are associated with increase in complication rates of hypoxemia (25%) [5] and hypotension (10–25%) [6], arrhythmia, cardiac arrest and death [7] upon exposure to airway

Incapacity to perform tracheal intubation at the first attempt "first pass success" has higher risk than that in OT and occurs in 30% of ICU intubations [8]. Many factors contribute to that; lack of competent and expert professional for intubation, patient's factors and pharmacological agents' dosage choices. This came with the conclusion of Fourth National Audit Project (NAP4), as it showed around 25% of airway management done in ICU & ED are associated with major adverse effects mostly due to the aforementioned factors [9]. Moreover, equipment unavailability, unfamiliarity and inadequate planning resulting in more stressful environment and subsequently delay in airway management with increasing morbidity and mortality. ICU settings are not suitably planned for airway management due to several reasons. Limited access to the patient as the bed space is crowded by monitoring, ventilator and other equipment, (**Figure 4**) in addition of the ICU bed is less maneuverable compared to the OT table with unavailability of advanced airway management equipment making it more challenging. Moreover, varying team members of multi-professional backgrounds with non-enough time, experience, accompanying medical devices (collars, masks) and sensorium alteration lead to improper airway assessment beside and inability to ensure adequate preoxygenation necessary to avoid the hypoxia during airway instrumentation. Moreover, unavailability of trained assistance such as anesthesia nurse or technician and lack of

Communication and proper documentation of the airway assessment and its management throughout different hospital facilities is crucial and it might affect the workflow performance. Checklist is the best method of communication among the healthcare professionals from different medical background. Equipment, medications preparation checklist and proper assignment of human forces could make the airway management scenario less stressful and empower its success among

securing definitive airway securing device suitable for MV.

*1.3.2 Assisted ventilation group*

**Figure 3.** *Oxygen delivery devices. (bag-mask with self-inflating reservoir bag).*

#### *1.3.2 Assisted ventilation group*

*Special Considerations in Human Airway Management*

*Oxygen delivery devices (simple face mask with reservoir bag & nasal cannula).*

**84**

**Figure 3.**

*Oxygen delivery devices. (bag-mask with self-inflating reservoir bag).*

**Figure 1.**

**Figure 2.**

*Oxygen delivery devices (HAFOE).*

In this group of critically ill patients, failure to maintain oxygenation and/ or ventilation despite an increase in FIO2 or development of apnea and indicated mechanical ventilation (MV), airway supporting device might be perpetual or temporary as a bridge till the steady one is fixed. Noninvasive positive pressure ventilation (NIPPV), could have both properties as it might be a tie till improvement or securing definitive airway securing device suitable for MV.

Bag-mask with self-inflating reservoir bag; (**Figure 3**) is considered the simplest and commonest O2 delivery device used in critically ill patients for oxygenation until an airway securing device fixed. It provides FIO2 close to 100% while the only O2 delivery device able to provide 100% FIO2 is the anesthetic breathing system.
