10-20% of the ICU population will be difficult to intubate- and this can lead to significant morbidity and mortality, as the excellent UK NAP4 audit showed NAP4: Executive summary | The Royal College of Anaesthetists

3% of patients will have an intubation related cardiac arrest…

Intubation related cardiac arrest circa 3%. However the following 30 day mortality is massively ⬆️ #lives2017 pic.twitter.com/JQZbkmfVUl

— #hellomynameis Segun (@iceman_ex) September 25, 2017

It’s been suggested that we treat every ICU patient as a difficult intubation. Assess the airway beforehand- the MACHOCA score has been recommended The MACOCHA score is feasible to predict intubation failure of … – NCBI

Tips to optimise intubation?

The 5 "P"s of optimising ICU intubation
I can see some controversies in here already. Discuss #lives2017 pic.twitter.com/wyrxVayDoB

— #hellomynameis Segun (@iceman_ex) September 25, 2017

Should we use VL first line? Maybe- but MACMAN says no thebottomline.org.uk/summaries/icm/…

And what about high flow oxygen as apnoeic oxygenation? Maybe ncbi.nlm.nih.gov/pubmed/25479117 or maybe not? emcrit.org/pulmcrit/apnei…

Or combine HFNC with non-invasive ventilation for the ultimate oxygenator? bmjopen.bmj.com/content/6/8/e0…

So some controversies remain- hopefully with more data to come we can make ICU intubation safer.