Intubation of critically ill patients in intensive care units: what's new in 2022?

This update describes the different strategies that can be implemented to secure intubation procedure in the ICU through optimisation of preoxygenation, airway management and endotracheal intubation in critically ill patients. These proposals are based on the latest French and international guidelines, as well as on the most recent literature on the subject. They emphasise the need for optimal anticipation and preparation for this period of high risk of complications. They also emphasise the need to take human factors into account, rather than simply introducing new devices or improving technical skills. They emphasise the role of the airway management team and of their communication, and the use of validated protocols and readily available cognitive aids. Proposed optimal management is presented in an algorithm. The importance of limiting attempts, recognising failure early, and moving to the next step in the algorithm are emphasised. They recommend the early use of a videolaryngoscope (if possible, with a remote screen visible to all), and supraglottic devices to oxygenate the patient in case of failure. In case of "can't intubate-can't oxygenate situation'', cricothyroidotomy using the scalpel, finger, and bougie procedure is suggested. Additional suggestions are made regarding the management of haemodynamics and peri-intubation mechanical ventilation.