The Role of the Critical Airway Team

A critical airway is a life-threatening scenario of hypoxemia about to become hypoxia following failed or inadequate ventilation. In such systems, esophageal intubation compounds the criticality of the situation as, besides the loss of oxygenation, the risk of stomach contents being aspirated into the airways is enhanced by ventilating into the stomach. Cervical spine injury or non-exclusion is not an issue, as almost always endotracheal intubation (ETI) can be done with little head manipulation and without neck manipulation; the problem would lie, in the end, on whether the patient can be ventilated or not. Indications for surgical airway in elective scenarios, specifically for tracheostomy, are well established in the intensive care unit (ICU). It is required for medium-to-long-term ventilation and advised as an early procedure in head injury with coma expected not to recover in the short term; in patients with any cancer in the neck compressing the trachea, and it is often the only practicable procedure for inoperable cancer or as an airway control procedure before or during surgery; after thyroid surgery in patients with longstanding goiter and tracheomalacia, as a tracheostomy prevents postoperative airway obstruction; before surgery in some neck abscesses, as it protects the lower airways from accidental or spontaneous pus release into the lungs during the procedure.