As a discipline, anesthesiology has served to meaningfully advance patient safety. In this context, airway management in dedicated procedural settings has benefited from algorithmic guidance, novel pharmaceuticals, and technological advancements. Out of the OR, however, myriad physiologic and contextual factors conspire to complicate airway management. Such intubations are often emergent, performed in patients who are unstable, and require the clinician to work in suboptimal conditions with little time to prepare or examine the patient (West J Emerg Med 2015;16:1109-17).

A recent international prospective observational study (INTUBE) of 2,964 critically ill adults undergoing intubation in the ICU demonstrated that physiologic difficulty associated with airway management is more common than technical, or anatomic, difficulty (JAMA 2021;325:1164-72). Peri-intubation cardiovascular instability accompanied 42.6% of all intubations, followed by severe hypoxemia in 9.3%, and cardiac arrest in 3.1%. Meanwhile, only 4.5% of intubations required more than two attempts, and only five...

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