Identification of difficult airways in critical care units (ID-ACCT): a multicentre, survey-based prospective observational study.

Abstract

Airway-related complications are common in ICUs and cause serious patient harm. We determined the prevalence of known and predicted difficult airways in ICU patients in the UK, assessed whether these patients are identifiable as at risk, and evaluated the presence of airway management plans through local investigator-led bedside assessment. We conducted a prospective, multicentre, observational study in 106 UK ICUs. Adult patients without treatment escalation plans precluding artificial airway insertion were included. Patients with known difficult airways (defined as difficulty in face-mask ventilation, laryngoscopy, or intubation) or predicted difficult airways (defined as BMI ≥30 kg m^-2, tracheostomy in situ, pathology or recent surgery affecting airway management, or modified MACOCHA score ≥3) were evaluated. Presence of clear identification and airway management planning for at-risk patients was assessed by local investigators. Amongst 1965 patients, 872 (44.4%) had an artificial airway in situ (tracheal tube n=639 [73.3%], tracheostomy tube n=233 [26.7%]). Among 1519 patients with intubation details, 244 (16.1%) had a known difficult airway (difficult face-mask ventilation n=32 [2.1%], laryngoscopy n=37 [2.4%], intubation n=182 [12.0%]). In this population, 70 (28.7%) were clearly identifiable to investigators, and 75 (30.7%) had airway management plans. Excluding patients with a known difficult airway, 922 patients had predicted difficult airway management, of whom 125 (13.6%) were clearly identifiable and 181 (19.6%) had airway management plans. Known and predicted difficult airways are common in UK ICU patients, but these at-risk patients are often not clearly identifiable to healthcare professionals.