How I manage a difficult intubation

Anatomical and physiological difficulties are often unable to be anticipated based on a pre-intubation assessment [1, 2]. [...]to be prepared for an unanticipated difficult intubation, we complete the following in a standardized fashion for all intubations [3]. The PreVent trial excluded patients with very high risk for aspiration (e.g., vomiting, hematemesis, hemoptysis). [...]for patients with very high risk of aspiration, we provide supplemental oxygen alone without positive pressure after induction, whereas for patients at high risk for hypoxemia and without high-risk features for aspiration, we provide positive pressure ventilation with either BiPAP or bag-mask ventilation between induction and laryngoscopy. Conclusion Difficult intubations cannot always be predicted. [...]our approach involves standardized preparation and execution of each intubation in a manner that can address anatomical or physiological difficulties as they are encountered. Non-invasive ventilation versus high-flow nasal cannula oxygen therapy with apnoeic oxygenation for preoxygenation before intubation of patients with acute hypoxaemic respiratory failure: a randomised, multicentre, open-label trial.