Airway Management and Intubation

Airway management is the set of techniques used to establish, maintain, and protect a patent airway so that oxygen can reach the lungs. It ranges from simple manoeuvres and adjuncts that relieve obstruction to definitive airway control by endotracheal intubation, and it is the first physiologic priority in acute and critical care.

Definition

Airway management is the assessment and intervention used to keep the upper airway open and protected and, when required, to secure a definitive airway by placing a tube in the trachea to permit ventilation and prevent aspiration.

Scope

The topic covers airway assessment, basic manoeuvres and adjuncts, supraglottic devices, endotracheal intubation as the definitive airway, and the concept of the anticipated and unanticipated difficult airway. It also addresses the nurse's role in preparing for, assisting with, and monitoring after airway interventions, framed as reference knowledge rather than procedural instruction.

Core questions

• Is the airway patent, and is it at risk of obstruction or aspiration?
• What level of intervention does the airway require, from positioning to intubation?
• How is a difficult airway anticipated and prepared for?
• How is correct tube placement confirmed and monitored over time?

Key concepts

• Airway patency and protection
• Basic manoeuvres and airway adjuncts
• Supraglottic airway devices
• Endotracheal intubation as definitive airway
• Difficult-airway anticipation
• Confirmation of tube placement (capnography)
• Aspiration risk

Mechanisms

An open airway is the conduit for all gas exchange; loss of muscle tone, secretions, blood, vomitus, or swelling can occlude it. Simple measures such as repositioning and airway adjuncts overcome soft-tissue obstruction, while a cuffed endotracheal tube placed in the trachea provides a definitive airway that both guarantees patency and isolates the lungs from aspirated material, allowing positive-pressure ventilation. Because intubation can fail or be anatomically difficult, structured approaches anticipate difficulty and prepare alternative techniques, and placement is confirmed by waveform capnography because exhaled carbon dioxide indicates the tube is in the trachea.

Clinical relevance

Airway management is central to resuscitation, anaesthesia, and the care of patients with depressed consciousness or respiratory failure, and nurses participate in assessment, preparation, assistance, and post-intubation monitoring. This entry summarizes the concepts as reference material and does not provide instructions for performing airway procedures on a patient.

History

Modern airway management grew out of twentieth-century anaesthesia and resuscitation, as endotracheal intubation moved from the operating theatre into emergency and critical care. Recurrent harm from unrecognized difficult airways led professional societies to publish structured difficult-airway algorithms and to adopt waveform capnography as the standard confirmation of tracheal placement.

Seminal works

• apfelbaum-2013

Frequently asked questions

What makes an endotracheal tube a 'definitive' airway?

A cuffed tube seated in the trachea both keeps the airway open and seals the lower airway against aspiration, while allowing positive-pressure ventilation; simpler adjuncts keep the airway open but do not provide this protection.

How is correct placement of a breathing tube confirmed?

Detection of exhaled carbon dioxide by waveform capnography is the standard confirmation that the tube is in the trachea rather than the oesophagus, supplemented by clinical signs such as bilateral chest rise and breath sounds.