The Physiologically Dif cult Airway

Airway management in critically ill patients involves the identi cation and management of the potentially dif cult airway in order to avoid untoward complications. This focus on dif cult airway management has traditionally referred to identifying anatomic characteristics of the patient that make either visualizing the glottic opening or placement of the tracheal tube through the vocal cords dif cult. This paper will describe the physiologically dif cult airway, in which physiologic derangements of the patient increase the risk of cardiovascular collapse from airway management. The four physiologically dif cult airways described include hypoxemia, hypotension, severe metabolic acidosis, and right ventricular failure. The emergency physician should account for these physiologic derangements with airway management in critically ill patients regardless of the predicted anatomic dif culty of the intubation. [West J Emerg Med. 20XX;XX(X):XX-XX.]