Indications
- • Airway protection (GCS ≤8, anticipated deterioration)
- • Respiratory failure unresponsive to NIV
- • Cardiac arrest / peri-arrest
- • Operative / procedural
Contraindications
- ⚠ Difficult airway predicted — call anaesthetics / consider awake fibreoptic
Equipment
- • Pre-oxygenation: BVM, NRB, NPA/OPA
- • Laryngoscope (Mac 3/4 or video)
- • ETT 7.0–8.0 (F/M), cuffed
- • Bougie, stylet
- • 10 mL syringe for cuff
- • Suction, capnography, monitoring
- • RSI drugs (induction + paralytic) + post-intubation sedation
- • Difficult airway trolley
Technique
- • Plan: assess airway (MOANS, LEMON), prepare team, drugs, equipment
- • Pre-oxygenate 3 min 100% O₂ + apnoeic O₂
- • Position: ear-to-sternal-notch, ramp obese patients
- • RSI: induction + paralytic (ketamine 1–2 mg/kg + rocuronium 1.2 mg/kg)
- • Laryngoscopy, identify vocal cords, pass ETT through cords to depth ~21 (F) / 23 (M) cm at lips
- • Inflate cuff, attach capnography
- • Confirm: ETCO₂ sustained, bilateral chest rise, auscultation, SpO₂
- • Secure tube, start ventilation + sedation, CXR for position
Complications
- ⚠ Hypoxia, hypotension
- ⚠ Oesophageal intubation
- ⚠ Aspiration
- ⚠ Dental / soft tissue trauma
- ⚠ Right main bronchus intubation
Aftercare
- • Sedation + analgesia plan (propofol + fentanyl)
- • Lung-protective ventilation (Vt 6 mL/kg IBW)
- • Daily sedation hold and SBT
Clinical pearls
- • No ETCO₂ = no intubation — assume oesophageal until proven otherwise
- • Cuff pressure 20–30 cmH₂O
- • Have a plan A/B/C/D per DAS guidelines
Perform under supervision until competent. Follow local SOPs and consent policy.
