Hospitals & Services
Endotracheal intubation in intensive care is a high risk but vital emergency procedure in patients who often have limited reserve, are difficult to position and may have a difficult airway.
All staff should familiarise themselves with the intubation trolley and equipment.
Intubation should never be done by a lone operator – if you are alone or inexperienced, always call for assistance. If the duty intensive care specialist cannot be reached for some reason, or is detained, then assistance should be sought from an anaesthetic colleague.
Rapid sequence induction is the rule in intensive care patients unless previously discussed with the duty intensive care specialist.
Patients at risk of aspiration
Altered conscious state
To maintain airway
Upper airway obstruction or threat
Control of arterial carbon dioxide content (eg; in the setting of traumatic brain injury)
Orotracheal intubation is the rule.
All patients returning from theatre (or transported from another centre) may have a different ET tube (eg; Armoured ETT) in situ. Where there is no good reason for this to remain (eg; Double lumen ETT in a patient with ongoing pulmonary haemorrhage), it should be changed to the standard ETT if it is anticipated that the patient will require intubation >48 hrs, and would not be exposed to significant risk during the ETT change.