Airway Management in ICU: Three Years on from NAP4

The 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society; major complications of airway management in the UK (NAP4) reported that the intensive care unit (ICU), rather than being a place of safety for airway management, could instead be considered a place of danger (Cook et al. 2011a). Airway-related complications were more likely to occur on ICU than in theatre, and more likely to result in patient harm: the rate of airway-related complications on ICU was more than 50 times that during anaesthesia, and 50% of patients reported to NAP4 from ICU died, compared to 14% of those reported from theatres (Cook et al. 2011a; Whitaker 2011). Whereas most airway complications during anaesthesia arose at intubation (Cook et al. 2011a), the majority of life-threatening airway events on ICU involved accidental airway dislodgement, especially of tracheostomies. Difficulties associated with rapid sequence intubation and failures of airway rescue techniques were also seen.