Fig. 1.

Airway management algorithm. The availability of equipment for management of a difficult airway is checked. During the procedure, the patient should be ventilated in case of desaturation < 90%. All the intubation procedures performed in ICU are complicated. To improve first-attempt success, two operators, the use of a metal blade and the use of a malleable stylet (except for channeled videolaryngoscopes) are recommended. A rapid sequence induction is mandatory. In case of predicted difficult intubation (Mallampati score III or IV, OSAS, reduced mobility of cervical spine, limited mouth opening, coma, severe hypoxia, non-anesthesiologist (MACOCHA) score ≥ 3), the use of a videolaryngoscope is recommended if the operator is expert in using it (at least 15 intubations performed using the device), excepted in case of abundant secretions. If the MACOCHA score < 3, the choice of the device is left at the operator discretion (direct laryngoscope or videolaryngoscope). In case of intubation failure, a videolaryngoscope will be used if not used first, and/or an intubating stylet (malleable stylet or long flexible angulated stylet), followed successively using Laryngeal Mask Airway or fastrach, the use of fiberscopy in expert hands and finally the use of rescue percutaneal or surgical airway