Airway management outside the operating room: hazardous and incompletely studied.

PURPOSE OF REVIEW

The review examines recent knowledge regarding techniques and complications of airway management in hospitals, outside the operating room. The review does not consider airway management at the time of cardiopulmonary resuscitation as this is a separate topic.

RECENT FINDINGS

There is a relative paucity of high-quality and interventional studies with most being observational in nature. The available data confirm the high-risk nature of airway management outside the operating room. Recent studies indicate that complications, particularly in intensive care, occur more frequently after airway placement than at the time of placement. Avoidable harm due to lack of appropriate personnel, equipment and monitoring, most notably capnography, is noted. Although airway management outside the operating room remains a high-risk procedure, the optimal organizational structure, rescue procedures, algorithms and appropriate personnel have yet to be adequately defined.

SUMMARY

The notably high rate of failure of primary intubation attempts and high complication rates of airway procedures create a strong argument for increased research focus in this area of high-risk and incomplete knowledge.