Airway Management in the Neurointensive Care Unit

Airway management in the critically ill can be very challenging. The pathophysiology of underlying conditions, disparities in equipment, providers’ skills, and availability of adequately trained staff are essential issues and play a pivotal role in patient outcomes. Neuro-critically ill patients require special considerations. Optimization of oxygenation before and during attempts of airway management, monitoring pulse oximetry, electrocardiogram, blood pressure monitoring, and capnography should be available. Peri-intubation cardiovascular instability occurs frequently and is associated with severe complications and death. Hemodynamic stability maintains adequate cerebral perfusion pressure; extreme blood pressure fluctuation during instrumentation attempts should be avoided. Management of airway emergencies should focus on coordinated team efforts to reestablish airway patency, oxygenation, and ventilation restoration.