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Expertise in airway management is a vital skill for any provider caring for critically ill patients. A growing body of literature has identified the stark difference in periprocedural outcomes of elective intubation in the operating room when compared with emergency intubation in the ICU. A number of strategies to reduce the morbidity and mortality associated with airway management in the critically ill have been described. In this review, we provide an updated framework for airway assessment before direct laryngoscopy and video laryngoscopy, and use of newer pharmacologic agents; comment on current concepts in tracheal intubation in the ICU; and address human factors around critical decision-making during ICU airway management. [ABSTRACT FROM AUTHOR]

Background: The rates of central line-associated bloodstream infections (CLABSIs) in U.S. ICUs have decreased significantly, and a parallel reduction in the rates of total hospital-onset bacteremias in these units should also be expected. We report 10-year trends for total hospital-onset ICU-associated bacteremias at a tertiary-care academic medical center.Methods: This was a retrospective analysis of all positive-result blood cultures among patients admitted to seven adult ICUs for fiscal year 2005 (FY2005) through FY2014 according to Centers for Disease Control and Prevention National Healthcare Safety Network definitions. The rate of change for primary and secondary hospital-onset BSIs was determined, as was the distribution of organisms responsible for these BSIs. Data from three medical, two general surgical, one combined neurosurgical/trauma, and one cardiac/cardiac surgery adult ICU were analyzed.Results: Across all ICUs, the rates of primary BSIs progressively fell from 2.11/1,000 patient days in FY2005 to 0.32/1,000 patient days in FY2014; an 85.0% decrease (P < .0001). Secondary BSIs also progressively decreased from 3.56/1,000 to 0.66/1,000 patient days; an 81.4% decrease (P < .0001). The decrease in BSI rates remained significant after controlling for the number of blood cultures obtained and patient acuity.Conclusions: An increased focus on reducing hospital-onset infections at the academic medical center since 2005, including multimodal multidisciplinary efforts to prevent central line-associated BSIs, pneumonia, Clostridium difficile disease, surgical site infections, and urinary tract infections, was associated with progressive and sustained decreases for both primary and secondary hospital-onset BSIs. [ABSTRACT FROM AUTHOR]

The author stresses the importance of anesthesiologists in managing airway emergencies in the intensive care unit (ICU). The assessment of risk factors for difficult intubation (DI) and difficult ventilation and the high rate of complications of emergency endotracheal intubation (EEI) in critically ill patients are discussed. According to the author, studies have shown improved patient outcomes when clinicians trained in anesthesiology are the ones who perform emergent airway management.

The article focuses on an analysis of endotracheal intubation (EEI) significance in an intensive care unit (ICU) services along with risks over its usage. Topics discussed include assessment of different issues related to an intubation usage such as hypoxemia; consideration of ramped position for patient while usage of EEI services in an operating room (OR); and analysis of arterial oxygen saturation conditions with performance of EEI through direct laryngoscopy (DL).

The author offers his counterargument against the article "Counterpoint: Should an Anesthesiologist Be the Specialist of Choice in Managing the Difficult Airway in the ICU? Not Necessarily," by Kevin Doerschug published in the present issue of the journal "Chest." He explains the difference in complication rates of emergency endotracheal intubations (EEIs) between nonanesthesia and anesthesia providers. He asserts that anesthesiologists are best equipped to handle difficult airway management.