Abstract

This review delves into the complexities of difficult airway management in intensive care units (ICUs). We categorise difficult airway management into five classes according to the American Society of Anesthesiologists guidelines. The review highlights the higher incidence of difficult airway cases in ICUs compared to operating rooms, attributed to various factors such as the critical status of ICU patients, fluid therapy complications, and the emergency nature of many intubations. We discuss the effectiveness of traditional anatomical indices in predicting difficult airways, noting their limited predictive value. We also propose a difficult airway algorithm for ICU settings, which adapts to three potential scenarios: anticipated, unanticipated, and critical “Can’t Intubate Can’t Ventilate” situations. This algorithm is complemented by the Vortex Approach, a cognitive tool designed to streamline decision-making in difficult airway scenarios. We conclude with best practice recommendations adapted from the National Audit Project 4, emphasising the need for specialised training, equipment readiness, and a collaborative team approach in ICU airway management.