At our institution, medical house staff perform oral endotracheal intubation outside the operating room and surgical services. During the MICU rotation, management of the airway is reviewed. This review emphasizes the importance of airway evaluation, preoxygenation using bag-mask-valve ventilation with 100% oxygen, techniques of conventional oral endotracheal intubation on the mannequin, and management of the difficult airway. Equipment for conventional oral endotracheal intubation and the difficult airway are reviewed in the MICU. The difficultairway cart consists of equipment for the PTJV, a fiberoptic bronchoscope, an endotracheal tube exchange tube, and a tracheostomy tray. The placement of the endotracheal tube using the fiberoptic bronchoscope is the responsibility of pulmonary fellow and the MICU attending physician. Surgical management of the airway is the responsibility of the surgical services. comments
The technique, indications, contraindications, and the complications of PTJV are reviewed with the rotating medical house staff in the MICU. The house staff performs PTJV for oxygenation only after two unsuccessful attempts of oral endotracheal intubation, when they are unable to oxygenate with bag-valve-mask ventilation, and when physicians skilled in airway management are not immediately available. At our institution, the respiratory therapist assists during airway management, including administering bag-mask-valve ventilation. The MICU attending physician, the senior pulmonary fellow, and the anesthesiologist are considered skilled physicians for airway management and are available during working hours. At other times, the MICU attending physician on call is available for the management of the airway. The skilled physician makes the decision to perform conventional oral endotracheal intubation with or without rapid sequence intubation.