Airway Management in the ICU and Emergency Department in Resource-Limited Settings

TL;DR

This paper reviews strategies for managing airways in emergency and ICU settings where resources are limited, focusing on safe and effective techniques.

Contribution

The paper provides context-adapted airway management strategies tailored for resource-limited environments.

Findings

Physiology-first preparation and simplified rapid-sequence intubation are emphasized for resource-limited settings.

Basic airway adjuncts and supraglottic devices can be effectively used when advanced tools are unavailable.

Adapted difficult airway algorithms and front-of-neck access are recommended in the absence of surgical backup.

Abstract

Airway management is central to the care of critically ill patients, yet it remains one of the most challenging interventions in emergency departments and intensive care units. Patients often present with severe physiological instability, limited cardiopulmonary reserve, and high acuity, while clinicians often work under constraints related to time for preparation, equipment availability, trained workforce, monitoring, and access to advanced rescue techniques. These challenges are particularly pronounced in low- and middle-income countries and other resource-limited or austere environments, where the margin for error is narrow and delays or repeated attempts in airway management may rapidly precipitate hypoxemia, hemodynamic collapse, or cardiac arrest. Although contemporary airway guidelines emphasize structured preparation and rescue pathways, many assume resources that are not consistently available in such settings. This narrative review discusses pragmatic, context-adapted strategies for airway management in constrained environments, with emphasis on physiology-first preparation, appropriate oxygenation and induction techniques, simplified rapid-sequence intubation, and the judicious use of basic airway adjuncts, supraglottic devices, and video laryngoscopy, where available. Adapted difficult airway algorithms, front-of-neck access in the absence of surgical backup, human factors, team training, and ethical considerations are also addressed. This review aims to support safer and effective airway management for critically ill patients in resource-limited emergency and intensive care settings.

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