Tracheal intubation is a frequent and high-risk procedure in critically ill adults, with a global study of nearly 3,000 patients revealing major peri-intubation adverse events in 45% of cases—primarily cardiovascular collapse (43%) and severe hypoxemia (9%).

These complications are linked to higher ICU and 28-day mortality. Unlike anatomically difficult airways, critically ill patients often face a physiologically difficult airway, where underlying pathophysiology heightens risks during intubation and the shift to positive pressure ventilation, compounded by operator variability and chaotic environments.

This narrative review synthesizes strategies from airway societies and experts to enhance safety and efficacy, including preoxygenation optimization, hemodynamic stabilization, videolaryngoscopy use, and checklists. While drawing from diverse settings (ICU, emergency, and operating rooms), targeted approaches addressing physiological vulnerabilities can mitigate risks and improve outcomes in these vulnerable patients.

Read More