Original Publication
Open Access

ICU Difficult Airway Simulation

Published: July 26, 2010 | 10.15766/mep_2374-8265.8091

Included in this publication:

  • IERC SimMan Diff Airway.docx

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Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


This simulation prepares learners to assess, prepare for, and secure the ICU airway; review and practice using the American Society of Anesthesiologists (ASA) Difficult Airway Algorithm; and review the steps necessary to perform a cricothyroidotomy. The simulation is designed to review and strengthen resident airway skills prior to managing potentially difficult airways independently. Unique aspects of the ICU airway and strategies for management are highlighted and discussed. The simulation offers an opportunity to review and practice using the ASA Difficult Airway Algorithm and reviews the cricothyroidotomy procedure.

Educational Objectives

By the end of this simulation, learners will be able to:

  1. Describe and perform airway and clinical assessment in an ICU patient.
  2. Identify potential risk factors for a difficult ventilation and intubation.
  3. Optimize monitoring and positioning of the ICU patient prior to induction.
  4. Discuss indications/contraindications for rapid-sequence induction.
  5. Discuss various strategies for induction of anesthesia in the ICU patient.
  6. Familiarize themselves with the code airway backpack contents, ensuring the ability to find and utilize equipment needed from airway backpack for induction.
  7. Recognize a difficult airway, when they need help with an airway, and when to ask for help from the senior resident or staff.
  8. Direct available resources to manage and secure a difficult airway.
  9. Demonstrate proficiency in advanced airway management, including bag-mask ventilation, use of oral and nasal airways, LMA placement, direct laryngoscopy, and cricothyroidotomy.
  10. List alternative options for airway management when a given technique fails.
  11. Identify landmarks and describe technique to perform a cricothyroidotomy.

Author Information

  • Amanda Murray, MD: University of Minnesota Medical School
  • Mojca Konia, MD: University of Minnesota Medical Center

None to report.

None to report.


  1. Miller's Anesthesia, Ch.42, Airway Management
  2. American Society of Anesthesiologists Task Force on Difficult Airway Management. Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2003;98(5):1269-1277. http://dx.doi.org/10.1097/00000542-200305000-00032 
  3. Reynolds, et al. Airway Management of the Critically Ill Patient: Rapid Sequence Intubation. Chest. 2005;127:1397-1412. http://dx.doi.org/10.1378/chest.127.4.1397 


Murray A, Konia M. ICU difficult airway simulation. MedEdPORTAL. 2010;6:8091. https://doi.org/10.15766/mep_2374-8265.8091