The future of airway management: a selection of recent advances — Narrative review

Abstract

Airway management represents an essential yet huge chapter in the field of anesthesiology and critical care, being a pillar in a variety of scheduled, elective and/or urgent situations. It implies a multidisciplinary approach, a holistic vision, and a wide-ranging set of subskills. Specific relevant areas regarding airway have been arbitrarily selected for this narrative review and are noteworthy for their potential future use as breakthrough technologies. Airway ultrasonography (US) provides additional useful information about the anatomy and by combining that with classical clinical tests, improves the capacity to predict and anticipate a potential difficult intubation. High Flow Nasal Oxygenation (HFNO) can provide a high concentration of oxygen not only during preoxygenation in spontaneously breathing patients but also during the apneic phase, showcasing its abilities to produce positive airway pressure maintaining positive end-expiratory pressure (PEEP) and a high fraction of inspired oxygen. Furthermore, this technique provides minimal interference with the technical execution of bag-mask ventilation, laryngoscopy, and surgical interventions in the oropharynx. Intravenous oxygen (IVO2) is a new technique, already demonstrated in China and Asia, but present only with preliminary laboratory data in Europe and the United States. New technologies for delivery of this novel oxygen administration are currently being studied. Emerging data shows the application of these, and thus of IVO2, if effective and safe, could be extended to emergency settings to gain some bridging time to ExtraCorporeal Membrane Oxygenation (ECMO) or other interventions. Following approval there appears to be great scope as to how IVO2 could be implemented in perioperative medicine, e.g., as a tool used in pre-oxygenation before induction of general anesthesia, especially in critical ill patients.

A continuum of these relatively new techniques – US, HFNO, IVO2 – used in combination in the practice of perioperative medicine may change the way we plan for anticipated or unanticipated complications and manage the difficult airway, allowing us to offer the best possible pioneering care to our patients.