Respiratory distress is a serious issue in critical care units. Maintaining patent airways is the basic vital procedure in intensive care units. Maintain Airways (Airway Management) is performed by various methods depending on the extent of trauma and need of ventilation and oxygen saturation. Nurses assist patients round the clock for basic and advanced care. It will be of crucial importance for nurses to know and understand the various methods of airway maintenance in emergency and critical situations. Hence the present review focuses on various methods used in airway maintenance in intensive care units. The present article reviews the basic importance of airway, indication for airway maintenance in medical condition, pre-requisitions for airway maintenance, ladder approach for airway maintenance, devices used to monitor airway and role of critical care nurse in airway maintenance.

Keywords: Airway management, intensive care unit, emergency unit, types of airways, role of nurse

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1. Harless J, Ramaiah R, Bhananker SM. Pediatric airway management. Int J Crit Illn Inj Sci. 2014 Jan;4(1):65–70. doi: 10.4103/2229-5151.128015. PMID: 24741500; PMCID: PMC3982373.
2. Griscom NT, Wohl ME. Dimensions of the growing trachea related to age and gender. AJR Am J Roentgenol. 1986 Feb;146(2):233–7. doi: 10.2214/ajr.146.2.233. PMID: 3484568.
3. Shibasaki M, Nakajima Y, Ishii S, Shimizu F, Shime N, Sessler DI. Prediction of pediatric endotracheal tube size by ultrasonography. Anesthesiology. 2010 Oct;113(4):819–24. doi: 10.1097/ALN.0b013e3181ef6757. PMID: 20808208.
4. Newth CJ, Rachman B, Patel N, Hammer J. The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care. J Pediatr. 2004 Mar;144(3):333–7. doi: 10.1016/j.jpeds.2003.12.018. PMID: 15001938.
5. Piepho T, Kriege M, Byhahn C, Cavus E, Dörges V, Ilper H, et al. German guidelines for airway management 2023. Anaesthesiologie. 2024 May 16. doi: 10.1007/s00101-024-01413-5. Epub ahead of print. PMID: 38753159.
6. Long B, Gottlieb M. Emergency medicine updates: Endotracheal intubation. Am J Emerg Med. 2024 Nov;85:108–16. doi: 10.1016/j.ajem.2024.08.042. Epub 2024 Sep 3. PMID: 39255682.
7. Roberts K, Whalley H, Bleetman A. The nasopharyngeal airway: Dispelling myths and establishing the facts. Emerg Med J. 2005 Jun;22(6):394–6. doi: 10.1136/emj.2004.021402. PMID: 15911941; PMCID: PMC1726817.
8. Shen CM, Soong WJ, Jeng MJ, Lee YS, Cheng CY, Sun J, et al. Nasopharyngeal tract length measurement in infants. Acta Paediatr Taiwan. 2002 Mar–Apr;43(2):82–5. PMID: 12041622.
9. Davis DP, Koprowicz KM, Newgard CD, Daya M, Bulger EM, Stiell I, et al. The relationship between out-of-hospital airway management and outcome among trauma patients with Glasgow Coma Scale scores of 8 or less. Prehosp Emerg Care. 2011 Apr–Jun;15(2):184–92. doi: 10.3109/10903127.2010.545473. Epub 2011 Feb 10. PMID: 21309705; PMCID: PMC4091894.
10. Daugherty RJ, Nadkarni V, Brenn BR. Endotracheal tube size estimation for children with pathological short stature. Pediatr Emerg Care. 2006 Nov;22(11):710–7. doi: 10.1097/01.pec.0000238743.96606.69. PMID: 17110862.
11. Mosier JM, Stolz U, Chiu S, Sakles JC. Difficult airway management in the emergency department: GlideScope video laryngoscopy compared to direct laryngoscopy. J Emerg Med. 2012 Jun;42(6):629–34. doi: 10.1016/j.jemermed.2011.06.007. Epub 2011 Sep 10. PMID: 21911279.

Respiratory distress is a serious issue in critical care units. Maintaining patent airways is the basic vital procedure in intensive care units. Maintain Airways (Airway Management) is performed by various methods depending on the extent of trauma and need of ventilation and oxygen saturation. Nurses assist patients round the clock for basic and advanced care. It will be of crucial importance for nurses to know and understand the various methods of airway maintenance in emergency and critical situations. Hence the present review focuses on various methods used in airway maintenance in intensive care units. The present article reviews the basic importance of airway, indication for airway maintenance in medical condition, pre-requisitions for airway maintenance, ladder approach for airway maintenance, devices used to monitor airway and role of critical care nurse in airway maintenance.

Keywords: Airway management, intensive care unit, emergency unit, types of airways, role of nurse

🔒 This is a subscription article

Full text is available to subscribers and institutional members. Please choose an option below to access it.

1. Harless J, Ramaiah R, Bhananker SM. Pediatric airway management. Int J Crit Illn Inj Sci. 2014 Jan;4(1):65–70. doi: 10.4103/2229-5151.128015. PMID: 24741500; PMCID: PMC3982373.
2. Griscom NT, Wohl ME. Dimensions of the growing trachea related to age and gender. AJR Am J Roentgenol. 1986 Feb;146(2):233–7. doi: 10.2214/ajr.146.2.233. PMID: 3484568.
3. Shibasaki M, Nakajima Y, Ishii S, Shimizu F, Shime N, Sessler DI. Prediction of pediatric endotracheal tube size by ultrasonography. Anesthesiology. 2010 Oct;113(4):819–24. doi: 10.1097/ALN.0b013e3181ef6757. PMID: 20808208.
4. Newth CJ, Rachman B, Patel N, Hammer J. The use of cuffed versus uncuffed endotracheal tubes in pediatric intensive care. J Pediatr. 2004 Mar;144(3):333–7. doi: 10.1016/j.jpeds.2003.12.018. PMID: 15001938.
5. Piepho T, Kriege M, Byhahn C, Cavus E, Dörges V, Ilper H, et al. German guidelines for airway management 2023. Anaesthesiologie. 2024 May 16. doi: 10.1007/s00101-024-01413-5. Epub ahead of print. PMID: 38753159.
6. Long B, Gottlieb M. Emergency medicine updates: Endotracheal intubation. Am J Emerg Med. 2024 Nov;85:108–16. doi: 10.1016/j.ajem.2024.08.042. Epub 2024 Sep 3. PMID: 39255682.
7. Roberts K, Whalley H, Bleetman A. The nasopharyngeal airway: Dispelling myths and establishing the facts. Emerg Med J. 2005 Jun;22(6):394–6. doi: 10.1136/emj.2004.021402. PMID: 15911941; PMCID: PMC1726817.
8. Shen CM, Soong WJ, Jeng MJ, Lee YS, Cheng CY, Sun J, et al. Nasopharyngeal tract length measurement in infants. Acta Paediatr Taiwan. 2002 Mar–Apr;43(2):82–5. PMID: 12041622.
9. Davis DP, Koprowicz KM, Newgard CD, Daya M, Bulger EM, Stiell I, et al. The relationship between out-of-hospital airway management and outcome among trauma patients with Glasgow Coma Scale scores of 8 or less. Prehosp Emerg Care. 2011 Apr–Jun;15(2):184–92. doi: 10.3109/10903127.2010.545473. Epub 2011 Feb 10. PMID: 21309705; PMCID: PMC4091894.
10. Daugherty RJ, Nadkarni V, Brenn BR. Endotracheal tube size estimation for children with pathological short stature. Pediatr Emerg Care. 2006 Nov;22(11):710–7. doi: 10.1097/01.pec.0000238743.96606.69. PMID: 17110862.
11. Mosier JM, Stolz U, Chiu S, Sakles JC. Difficult airway management in the emergency department: GlideScope video laryngoscopy compared to direct laryngoscopy. J Emerg Med. 2012 Jun;42(6):629–34. doi: 10.1016/j.jemermed.2011.06.007. Epub 2011 Sep 10. PMID: 21911279.