The physiologically difficult airway: an emerging concept

Purpose of review The physiologically difficult airway is one in which physiologic alterations in the patient increase the risk for cardiorespiratory and other complications during tracheal intubation and transition to positive pressure ventilation. This review will summarize the recent literature around the emerging concept of the physiologically difficult airway, describe its relevance and various patient types in which this entity is observed. Recent findings Physiologic derangements during airway management occur due acute illness, pre-existing disease, effects of anesthetic agents, and positive pressure ventilation. These derangements are especially recognized in critically ill patients, but can also occur in otherwise healthy patients including obese, pregnant and pediatric patients who have certain physiological alterations. Critically ill patients may have a physiologically difficult airway due to the presence of acute respiratory failure, hypoxemia, hypotension, severe metabolic acidosis, right ventricular failure, intracranial hypertension, and risk of aspiration of gastric contents during tracheal intubation. Understanding the physiological alterations and the risks involved in patients with a physiologically difficult airway is necessary to optimize the physiology and adopt strategies to avoid complications during tracheal intubation. Further research will help us better understand the optimal strategies to improve outcomes in these patients.

Automated summary

This review focuses on the concept of the physiologically difficult airway, in which physiological alterations in patients increase the risk of complications during tracheal intubation and positive pressure ventilation. The literature suggests that these physiological derangements can occur in critically ill patients as well as in otherwise healthy individuals who have certain physiological alterations. Understanding the risks involved and optimizing the physiology of patients with a physiologically difficult airway is crucial to avoid complications during airway management.