Physiologically Difficult Airway in the Patient with Severe Hypotension and Metabolic Acidosis
Table 1
Physiologically difficult airway and the common disturbances, underlying conditions, and mitigations.
Disturbance
Underlying conditions
Consequences
Prevention/mitigation
Consumption increase
Sepsis Acute respiratory distress syndrome Excited delirium Thyrotoxicosis Pregnancy Children
Rapid desaturation during apnea
Thorough preoxygenation Minimal apnea time Adequate oxygenation Anemia correction
Right ventricular failure
Severe pulmonary arterial hypertension Massive pulmonary embolism
Right ventricle dilation and tricuspid regurgitation (especially after fluids administration) Hypercapnia Atelectasis Hypoxemia
Bedside cardiac ultrasound Right ventricle afterload reduction: pulmonary vasodilators Avoidance of hypoxia, hypercapnia, and acidosis Thorough preoxygenation Apneic oxygenation Careful fluid administration Vasopressors
Acidosis (metabolic)
Diabetic ketoacidosis Lactic acidosis Salicylate intoxication Severe sepsis Major trauma
Suppressed compensatory hyperventilation and worsened acidosis
(Avoid intubation) (Noninvasive positive pressure ventilation) Maintenance of spontaneous respiration during intubation Minimal apnea time Underlying cause treatment
