The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit

Sheila Nainan Myatra; Syed Moied Ahmed; Pankaj Kundra; Rakesh Garg; Venkateswaran Ramkumar; Apeksh Patwa; Amit Shah; Ubaradka S Raveendra; Sumalatha Radhakrishna Shetty; Jeson Rajan Doctor; Dilip K Pawar; Singaravelu Ramesh; Sabyasachi Das; Jigeeshu Vasishtha Divatia

doi:10.4103/0019-5049.195485

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GUIDELINES 5 (AIDAA)

Year : 2016 | Volume : 60 | Issue : 12 | Page : 922-930

The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit

Sheila Nainan Myatra¹, Syed Moied Ahmed², Pankaj Kundra³, Rakesh Garg⁴, Venkateswaran Ramkumar⁵, Apeksh Patwa⁶, Amit Shah⁶, Ubaradka S Raveendra⁷, Sumalatha Radhakrishna Shetty⁷, Jeson Rajan Doctor¹, Dilip K Pawar⁸, Singaravelu Ramesh⁹, Sabyasachi Das¹⁰, Jigeeshu Vasishtha Divatia¹
¹ Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
² Department of Anaesthesiology and Critical Care, J N Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India
³ Department of Anaesthesiology and Critical Care, JIPMER, Puducherry, India
⁴ Department of Onco-Anaesthesiology and Palliative Medicine, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India
⁵ Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
⁶ Kailash Cancer Hospital and Research Centre; Department of Anaesthesia, Vadodara Institute of Neurological Sciences, Vadodara, Gujarat, India
⁷ Department of Anaesthesiology and Critical Care, K S Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
⁸ Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
⁹ Department of Anaesthesia , Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
¹⁰ Department of Anaesthesiology, North Bengal Medical College, Darjeeling, West Bengal, India

Correspondence Address:
Jigeeshu Vasishtha Divatia
Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai - 400 012, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0019-5049.195485

Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often life-saving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with a suboptimal evaluation of the airway and limited oxygen reserves despite adequate pre-oxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxaemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. Non-invasive positive pressure ventilation during pre-oxygenation improves oxygen stores in patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnoea before the occurrence of hypoxaemia. High-flow nasal cannula oxygenation at 60-70 L/min may also increase safety during TI in critically ill patients. Stable haemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

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