Airway, Difficult/Critical — Assess Airway — Clinical Pathway: All Settings

Difficult/Critical Airway Clinical Pathway — All Settings

Definitions for Difficult and Critical Airways

Difficult airway is a clinical situation in which a physician trained in advanced airway management has difficulty ventilating and/or intubating a patient when respiratory support is needed. A critical airway is a clinical situation in which ventilation or intubation is expected to be impossible without surgical intervention. Clinical indicators and methods of critical/difficult airways are listed below.

Please see Airway Emergency Notification and Escalation of Care Procedure for more information. View Procedure

Clinical Indicators of Difficult and Critical Airways

Difficult Airway
  • Known difficulty with intubation in the past
  • Anticipated challenges in securing a stable airway
  • Craniofacial, spinal or thoracic abnormalities
  • Disease specific anatomic abnormalities that may create difficulty with intubation either by limiting patient positioning or limiting insertion of the airway:
    • Severe scoliosis, unstable C-spine or limited head or neck flexion
    • Receding mandible, micrognathia, large tongue
    • Significant obesity
Critical Airway
  • Cannot be ventilated due to anatomic/other abnormalities if the endotracheal tube is dislodged
  • New tracheostomy
    • Less than 7 days in place or
    • First change by the Otolaryngology (ENT) or General Surgery Services has not occurred
  • Tracheostomy and cannot be bag-valve mask ventilated or intubated
  • Airway stenosis per ENT of ≥ grade III
  • Has a false tract, stoma granulation tissue that is obstructive, or another complication identified by caregivers
  • Has a laryngeal/tracheal stent in place