Airway management is often a difficult but vitally important skill in the ICU. The first responsibility of a practitioner assessing a critically ill patient is to assess the airway, and if any compromise or potential compromise is found, it must be dealt with as a first priority. Unlike a relatively healthy patient undergoing elective surgery, ICU patients frequently have a wide range of comorbidities, which limit physiology reserve. Therefore, when intubation in the ICU becomes necessary, it is very important for the entire care team to have an effective plan that involves both knowledge of the patient's medical problems and understanding of the various techniques for airway management. Modern airway management has evolved with the introduction of novel supraglottic devices and newer techniques for facilitating endotracheal intubation. This chapter will focus on the management of the difficult airway (DA) and the role of alternative airway devices for managing failed ventilation and/or intubation. It will also discuss techniques for tube changes and extubation in the DA.
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