Difficult Airway and Cannot Intubate, Cannot Ventilate Situations in Korea: What Can We Do in the Future?

I have read the article entitled “A Pilot Survey of Difficult Intubation and Cannot Intubate, Cannot Ventilate Situations in Korea” published by Kim et al. [1] in the Korean Journal of Critical Care Medicine in August 2016, with great interest. An official survey on difficult intubations is still a very meaningful pilot study in Korea. The authors suggested that the video laryngoscope is the most preferred modality among Korean anesthesiologists and intensivists for “Cannot Intubate, Cannot Ventilate (CICV)” and difficult intubation conditions. This preference reflects the results from a 2013 report of a survey performed in Canada [2]. I believe that these findings are valuable and should be actively applied in special conditions, such as in the intensive care unit (ICU). In general, patients in the ICU exhibit signs and symptoms of acute respiratory distress syndrome and sepsis. These patients lack a physiologic reserve when compared to other patients, and are often facing life-threatening conditions. Moreover, a difficult airway occurs more often outside the operating room, while the rate of incidence is 11% to 22% in critically ill patients [3,4]. Therefore, when compared to patients who undergo tracheal intubation for elective surgery in the operating room [1], it is more important to accurately predict a difficult airway and be successful on the first attempt at intubation in ICU patients [5]. Thus, if a difficult airway condition is predicted in ICU patients, it is necessary to proactively use the video laryngoscope on the first intubation attempt [6]. A prior prospective study reports that the use of the C-MAC video laryngoscope (Karl Storz, Tuttlingen, Germany), over the Macintosh blade, has increased the success rate of the first attempt at tracheal intubation in ICU patients suspected of having a difficult airway from 55% to 79% [7]. In light of these trends, intensive care staff in Korea should consider proactively assessing for difficult airways and using a video laryngoscope before a CICV situation ensues.