Physiologically Difficult Airway

The Physiologically Difficult Airway – Part 1

PulmCCM - Mar 11, 2016 - By Jon Emyle 

"To celebrate the birthday of Dr. Erin Hennessey – my former co-fellow and current Stanford intensivist-anesthesiologist – I will summarize a relatively recent and terrifically high-yield overview of physiologically challenging intubations. In this must-read survey, the authors highlight particularly troublesome intubations not from the classic, anatomical perspective, but from the standpoint of the – reasonably commonplace – physiologically moribund patient. The authors provide recommendations on each of the following concerning states when transitioning a patient from unassisted to assisted ventilation: hypoxemia, hypotension, severe metabolic acidosis and right ventricular failure."

• Hypoxemia
• Hypotension

Summary slide: NIPPV is non-invasive positive pressure ventilation; 

DSI is delayed sequence intubation; HFNC is high flow nasal cannula; 

NC is nasal cannula; VTI is velocity time integral; 

FRC is functional residual capacity

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The Physiologically Difficult Airway – Part 2

PulmCCM - Mar 18, 2016 - By Jon Emyle

"In part 2, I continue the summary of this excellent review; part 1 may be found here. In this post I will consider patients with severe metabolic acidosis and those with right ventricular [RV] dysfunction and/or failure."

• Severe Metabolic Acidosis
• Right Ventricular Failure