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Chapter 29. Unique Airway Issues in the Intensive Care Unit

What are the two most common complications associated with intubation in the ICU patient?

A. dental injury and mucosal laceration

B. dysrhythmia and hypertension

C. hypotension and hypoxemia

D. cannot intubate, cannot oxygenate

(C) Hypotension and hypoxemia are more common in the critically ill. These complications are associated with increased morbidity and mortality. The clinician should mitigate these complications with proper prevention and management as outlined in the text.

All of the following are reasonable approaches to a quality improvement program that may improve outcomes associated with intubations in the ICU EXCEPT

A. practicing in situ multidisciplinary simulation

B. difficult airway response team (DART)

C. reviewing what airway equipment is immediately available in the ICU

D. attending ICU Grand rounds

(D) Airway interventions in the ICU patient population have repeatedly been identified as high-risk situations leading to life-threatening complications that are more likely to lead to morbidity and mortality. Several quality improvement initiatives have been proven to improve peri-intubation safety in the critically ill.

All of the following are reasons why hypoxemia/desaturation is more common during airway interventions in the critically ill patient EXCEPT

A. increased oxygen may decrease their drive to breath

B. decreased functional residual capacity (FRC)

C. increased arterial–alveolar gradient

D. increased oxygen consumption

(A) Denitrogenation is more difficult in this patient population due to these physiologic reasons: B, C, and D. Desaturation during intubation can lead to anoxic brain injury, dysrhythmia, and death. The “safe apnea time” is significantly decreased. The text outlines several strategies to prevent this complication.

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