Challenges in Intensive Care Airway Management: A Comprehensive Review

Joana Berger-Estilita; Ekin Köselerli; Mustafa Kemal Bayar; Başak Ceyda Meço

doi:10.4274/atfm.galenos.2024.16769

Review

Challenges in Intensive Care Airway Management: A Comprehensive Review

Year 2024, Volume: 77 Issue: 3, 231 - 238, 10.10.2024

Joana Berger-Estilita Ekin Köselerli Mustafa Kemal Bayar Başak Ceyda Meço

Abstract

Bu derleme, yoğun bakım ünitelerinde (YBÜ) zor havayolu yönetiminin zorluklarını ele almaktadır. Amerikan Anestezi Uzmanları Derneği kılavuzlarına göre zor havayolu yönetimini beş sınıfa ayırıyoruz. Derleme, zor havayolu olgularının YBÜ’lerde operasyon odalarına kıyasla daha yüksek oluşunu vurgulamakta; bu durumun nedenleri arasında yoğun bakım hastalarının kritik durumu, sıvı terapisi komplikasyonları ve birçok entübasyonun acil niteliği bulunmaktadır. Geleneksel anatomik indekslerin zor havayollarını tahmin etmedeki etkinliğini tartışıp, bunların sınırlı tahmin değerlerine dikkat çekmeyi amaçlıyoruz. Ayrıca, YBÜ için üç potansiyel senaryoya uyum sağlayan bir zor havayolu algoritması öneriyoruz; öngörülen, beklenmeyen ve kritik “Entübe Edememe-Havalandıramama” durumları. Bu algoritma, zor havayolu senaryolarında karar almayı kolaylaştırmak için tasarlanmış bilişsel bir araç olan Vortex Yaklaşımı ile tamamlanmaktadır. YBÜ havayolu yönetiminde uzmanlaşmış eğitim, ekipman hazırlığı ve işbirlikçi ekip yaklaşımı ihtiyacını vurgulayan Ulusal Denetim Projesi 4’ten uyarlanan en iyi uygulama önerileriyle sonuca varıyoruz.

Keywords

Airway management , intensive care , intubation

Ethical Statement

J.B.-E., B.C.M., Concept: M.K.B., B.C.M., Design: J.B.-E., B.C.M., Data Collection and/or Processing: E.K., M.K.B., Analysis and/or Interpretation: J.B.-E., M.K.B., Literature Search: E.K., B.C.M., Writing: J.B.-E., E.K.

Supporting Institution

Thanks

References

1. Cook TM, Woodall N, Harper J, et al. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part
2: intensive care and emergency departments. Br J Anaesth. 2011;106:632-642. 2. Joffe AM, Aziz MF, Posner KL, et al. Management of Difficult Tracheal Intubation: A Closed Claims Analysis. Anesthesiology. 2019;131:818-829.
3. Peterson GN, Domino KB, Caplan RA, et al. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005;103:33-39.
4. Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136:31-81.
5. Admass BA, Endalew NS, Tawye HY, et al. Evidence-based airway management protocol for a critical ill patient in medical intensive care unit: Systematic review. Ann Med Surg (Lond). 2022;80:104284.
6. Edelman D, Brewster D. Airway management in the intensive care unit. Anaesthesia & Intensive Care Medicine. 2022;23:589-593.
7. Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med. 2006;34:2355-2361.
8. Noppens RR, Geimer S, Eisel N, et al. Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: a prospective, comparative study in the ICU. Crit Care. 2012;16:103.
9. Jarzebowski M, Estime S, Russotto V, et al. Challenges and outcomes in airway management outside the operating room. Curr Opin Anaesthesiol. 2022;35:109-114.
10. Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol. 2016;17:109.
11. Lavery GG, McCloskey BV. The difficult airway in adult critical care. Crit Care Med. 2008;36:2163-2173.
12. Esteban A, Alía I, Tobin MJ, et al. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1999;159:512-518.
13. Vallverdú I, Calaf N, Subirana M, et al. Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med. 1998;158:1855-1862.
14. Zein H, Baratloo A, Negida A, et al. Ventilator Weaning and Spontaneous Breathing Trials; an Educational Review. Emerg (Tehran). 2016;4:65-71.
15. Curry K, Cobb S, Kutash M, et al. Characteristics associated with unplanned extubations in a surgical intensive care unit. Am J Crit Care. 2008;17:45-52.
16. Nolan JP, Kelly FE. Airway challenges in critical care. Anaesthesia. 2011;66(Suppl 2):81-92.
17. Georgiou AP, Gouldson S, Amphlett AM. The use of capnography and the availability of airway equipment on Intensive Care Units in the UK and the Republic of Ireland. Anaesthesia. 2010;65:462-467.
18. Downing J, Yardi I, Ren C, et al. Prevalence of peri-intubation major adverse events among critically ill patients: A systematic review and meta analysis. Am J Emerg Med. 2023;71:200-216.
19. Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99:607-613.
20. Fluit CRMG, Phelan D, Ramsay G, et al. (PACT): An ESICM Multidisciplinary Distance Learning Programme for Intensive Care Trainig. Journal of the Intensive Care Society. 2004;4:69-104.
21. Crawley SM, Dalton AJ. Predicting the difficult airway. BJA Education. 2015;15:253-257.
22. el-Ganzouri AR, McCarthy RJ, Tuman KJ, et al. Preoperative Airway Assessment: Predictive Value of a Multivariate Risk Index. Anesth Analg. 1996;82:1197-1204.
23. Ezri T, Weisenberg M, Khazin V, et al. Difficult laryngoscopy: incidence and predictors in patients undergoing coronary artery bypass surgery versus general surgery patients. J Cardiothorac Vasc Anesth. 2003;17:321-324.
24. Farmery AD. Sternomental distance as predictor of difficult laryngoscopy. Br J Anaesth. 1997;78:626-627.
25. Kar S, Senapati LK, Samanta P, et al. Predictive Value of Modified Mallampati Test and Upper Lip Bite Test Concerning Cormack and Lehane’s Laryngoscopy Grading in the Anticipation of Difficult Intubation: A Cross- Sectional Study at a Tertiary Care Hospital, Bhubaneswar, India. Cureus. 2022;14:e28754. 26. Randell T. Prediction of difficult intubation. Acta Anaesthesiol Scand. 1996;40:1016-1023.
27. Savva D. Prediction of difficult tracheal intubation. Br J Anaesth. 1994;73:149-153.
28. De Jong A, Molinari N, Terzi N, et al. Early identification of patients at risk for difficult intubation in the intensive care unit: development and validation of the MACOCHA score in a multicenter cohort study. Am J Respir Crit Care Med. 2013;187:832-839.
29. Chrimes N. The Vortex: a universal ‘high-acuity implementation tool’ for emergency airway management. Br J Anaesth. 2016;117(Suppl 1):20-27.
30. Crosby ET, Cooper RM, Douglas MJ, et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth. 1998;45:757-776.
31. Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115:827 848.
32. Jung H. A comprehensive review of difficult airway management strategies for patient safety. Anesth Pain Med (Seoul). 2023;18:331-339.
33. Rosenblatt WH. Preoperative planning of airway management in critical care patients. Crit Care Med. 2004;32(4 Suppl):186-192.
34. Heidegger T. Management of the Difficult Airway. N Engl J Med. 2021;384:1836-1847.
35. Jabaley CS. Managing the Physiologically Difficult Airway in Critically Ill Adults. Crit Care. 2023;27:91.
36. Noppens RR. Airway management in the intensive care unit. Acta Clin Croat. 2012;51:511-517.
37. Natt B, Mosier J. Airway Management in the Critically Ill Patient. Curr Anesthesiol Rep. 2021;11:116-127.
38. Higgs A, McGrath BA, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018;120:323-352.
39. Knill RL. Difficult laryngoscopy made easy with a “BURP”. Can J Anaesth 1993;40:279-282.
40. De Jong A, Clavieras N, Conseil M, et al. Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before-after comparative study. Intensive Care Med. 2013;39:2144-2152.
41. Bokhari A, Benham SW, Popat MT. Management of unanticipated difficult intubation: a survey of current practice in the Oxford region. Eur J Anaesthesiol. 2004;21:123 127.
42. Latto IP, Stacey M, Mecklenburgh J, et al. Survey of the use of the gum elastic bougie in clinical practice. Anaesthesia. 2002;57:379-384.
43. Mehta S. Transtracheal illumination for optimal tracheal tube placement. A clinical study. Anaesthesia. 1989;44:970-972.
44. Davies PR, Tighe SQ, Greenslade GL, et al. Laryngeal mask airway and tracheal tube insertion by unskilled personnel. Lancet. 1990;336:977-979.
45. Liu ZJ, Yi J, Chen WY, et al. Comparison of learning performance of 2 intubating laryngeal mask airways in novice: A randomized crossover manikin study. Medicine (Baltimore). 2017;96:e6905.
46. Kihara S, Watanabe S, Brimacombe J, et al. Segmental cervical spine movement with the intubating laryngeal mask during manual in-line stabilization in patients with cervical pathology undergoing cervical spine surgery. Anesth Analg. 2000;91:195-200.
47. Lalwani J, Dubey KP, Sahu BS, et al. ProSeal laryngeal mask airway: An alternative to endotracheal intubation in paediatric patients for short duration surgical procedures. Indian J Anaesth. 2010;54:541-545.
48. Amalric M, Larcher R, Brunot V, et al. Impact of Videolaryngoscopy Expertise on First-Attempt Intubation Success in Critically Ill Patients. Crit Care Med. 2020;48:889-896.
49. Jaber S, Jung B, Corne P, et al. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med. 2010;36:248-255.
50. Corl KA, Dado C, Agarwal A, et al. A modified Montpellier protocol for intubating intensive care unit patients is associated with an increase in first-pass intubation success and fewer complications. J Crit Care. 2018;44:191-195.
51. Fong KM, Au SY, Ng GWY. Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials. Crit Care. 2019;23:319.
52. Weingart SD. Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department. J Emerg Med. 2011;40:661-667.
53. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59:165-175.
54. Sakles JC, Pacheco GS, Kovacs G, et al. The difficult airway refocused. Br J Anaesth. 2020;125:18-21.
55. Hickey AJ, Cummings MJ, Short B, et al. Approach to the Physiologically Challenging Endotracheal Intubation in the Intensive Care Unit. Respir Care. 2023;68:1438 1448.
56. Ahmed A, Azim A. Difficult tracheal intubation in critically ill. J Intensive Care. 2018;6:49.
57. Russotto V, Myatra SN, Laffey JG, et al. Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries. JAMA. 2021;325:1164-1172.

Yoğun Bakım Havayolu Yönetimindeki Zorluklar: Kapsamlı Bir Derleme

Year 2024, Volume: 77 Issue: 3, 231 - 238, 10.10.2024

Joana Berger-Estilita Ekin Köselerli Mustafa Kemal Bayar Başak Ceyda Meço

Abstract

References

1. Cook TM, Woodall N, Harper J, et al. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part
2: intensive care and emergency departments. Br J Anaesth. 2011;106:632-642. 2. Joffe AM, Aziz MF, Posner KL, et al. Management of Difficult Tracheal Intubation: A Closed Claims Analysis. Anesthesiology. 2019;131:818-829.
3. Peterson GN, Domino KB, Caplan RA, et al. Management of the difficult airway: a closed claims analysis. Anesthesiology. 2005;103:33-39.
4. Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136:31-81.
5. Admass BA, Endalew NS, Tawye HY, et al. Evidence-based airway management protocol for a critical ill patient in medical intensive care unit: Systematic review. Ann Med Surg (Lond). 2022;80:104284.
6. Edelman D, Brewster D. Airway management in the intensive care unit. Anaesthesia & Intensive Care Medicine. 2022;23:589-593.
7. Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Crit Care Med. 2006;34:2355-2361.
8. Noppens RR, Geimer S, Eisel N, et al. Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: a prospective, comparative study in the ICU. Crit Care. 2012;16:103.
9. Jarzebowski M, Estime S, Russotto V, et al. Challenges and outcomes in airway management outside the operating room. Curr Opin Anaesthesiol. 2022;35:109-114.
10. Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol. 2016;17:109.
11. Lavery GG, McCloskey BV. The difficult airway in adult critical care. Crit Care Med. 2008;36:2163-2173.
12. Esteban A, Alía I, Tobin MJ, et al. Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1999;159:512-518.
13. Vallverdú I, Calaf N, Subirana M, et al. Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med. 1998;158:1855-1862.
14. Zein H, Baratloo A, Negida A, et al. Ventilator Weaning and Spontaneous Breathing Trials; an Educational Review. Emerg (Tehran). 2016;4:65-71.
15. Curry K, Cobb S, Kutash M, et al. Characteristics associated with unplanned extubations in a surgical intensive care unit. Am J Crit Care. 2008;17:45-52.
16. Nolan JP, Kelly FE. Airway challenges in critical care. Anaesthesia. 2011;66(Suppl 2):81-92.
17. Georgiou AP, Gouldson S, Amphlett AM. The use of capnography and the availability of airway equipment on Intensive Care Units in the UK and the Republic of Ireland. Anaesthesia. 2010;65:462-467.
18. Downing J, Yardi I, Ren C, et al. Prevalence of peri-intubation major adverse events among critically ill patients: A systematic review and meta analysis. Am J Emerg Med. 2023;71:200-216.
19. Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg. 2004;99:607-613.
20. Fluit CRMG, Phelan D, Ramsay G, et al. (PACT): An ESICM Multidisciplinary Distance Learning Programme for Intensive Care Trainig. Journal of the Intensive Care Society. 2004;4:69-104.
21. Crawley SM, Dalton AJ. Predicting the difficult airway. BJA Education. 2015;15:253-257.
22. el-Ganzouri AR, McCarthy RJ, Tuman KJ, et al. Preoperative Airway Assessment: Predictive Value of a Multivariate Risk Index. Anesth Analg. 1996;82:1197-1204.
23. Ezri T, Weisenberg M, Khazin V, et al. Difficult laryngoscopy: incidence and predictors in patients undergoing coronary artery bypass surgery versus general surgery patients. J Cardiothorac Vasc Anesth. 2003;17:321-324.
24. Farmery AD. Sternomental distance as predictor of difficult laryngoscopy. Br J Anaesth. 1997;78:626-627.
25. Kar S, Senapati LK, Samanta P, et al. Predictive Value of Modified Mallampati Test and Upper Lip Bite Test Concerning Cormack and Lehane’s Laryngoscopy Grading in the Anticipation of Difficult Intubation: A Cross- Sectional Study at a Tertiary Care Hospital, Bhubaneswar, India. Cureus. 2022;14:e28754. 26. Randell T. Prediction of difficult intubation. Acta Anaesthesiol Scand. 1996;40:1016-1023.
27. Savva D. Prediction of difficult tracheal intubation. Br J Anaesth. 1994;73:149-153.
28. De Jong A, Molinari N, Terzi N, et al. Early identification of patients at risk for difficult intubation in the intensive care unit: development and validation of the MACOCHA score in a multicenter cohort study. Am J Respir Crit Care Med. 2013;187:832-839.
29. Chrimes N. The Vortex: a universal ‘high-acuity implementation tool’ for emergency airway management. Br J Anaesth. 2016;117(Suppl 1):20-27.
30. Crosby ET, Cooper RM, Douglas MJ, et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth. 1998;45:757-776.
31. Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115:827 848.
32. Jung H. A comprehensive review of difficult airway management strategies for patient safety. Anesth Pain Med (Seoul). 2023;18:331-339.
33. Rosenblatt WH. Preoperative planning of airway management in critical care patients. Crit Care Med. 2004;32(4 Suppl):186-192.
34. Heidegger T. Management of the Difficult Airway. N Engl J Med. 2021;384:1836-1847.
35. Jabaley CS. Managing the Physiologically Difficult Airway in Critically Ill Adults. Crit Care. 2023;27:91.
36. Noppens RR. Airway management in the intensive care unit. Acta Clin Croat. 2012;51:511-517.
37. Natt B, Mosier J. Airway Management in the Critically Ill Patient. Curr Anesthesiol Rep. 2021;11:116-127.
38. Higgs A, McGrath BA, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018;120:323-352.
39. Knill RL. Difficult laryngoscopy made easy with a “BURP”. Can J Anaesth 1993;40:279-282.
40. De Jong A, Clavieras N, Conseil M, et al. Implementation of a combo videolaryngoscope for intubation in critically ill patients: a before-after comparative study. Intensive Care Med. 2013;39:2144-2152.
41. Bokhari A, Benham SW, Popat MT. Management of unanticipated difficult intubation: a survey of current practice in the Oxford region. Eur J Anaesthesiol. 2004;21:123 127.
42. Latto IP, Stacey M, Mecklenburgh J, et al. Survey of the use of the gum elastic bougie in clinical practice. Anaesthesia. 2002;57:379-384.
43. Mehta S. Transtracheal illumination for optimal tracheal tube placement. A clinical study. Anaesthesia. 1989;44:970-972.
44. Davies PR, Tighe SQ, Greenslade GL, et al. Laryngeal mask airway and tracheal tube insertion by unskilled personnel. Lancet. 1990;336:977-979.
45. Liu ZJ, Yi J, Chen WY, et al. Comparison of learning performance of 2 intubating laryngeal mask airways in novice: A randomized crossover manikin study. Medicine (Baltimore). 2017;96:e6905.
46. Kihara S, Watanabe S, Brimacombe J, et al. Segmental cervical spine movement with the intubating laryngeal mask during manual in-line stabilization in patients with cervical pathology undergoing cervical spine surgery. Anesth Analg. 2000;91:195-200.
47. Lalwani J, Dubey KP, Sahu BS, et al. ProSeal laryngeal mask airway: An alternative to endotracheal intubation in paediatric patients for short duration surgical procedures. Indian J Anaesth. 2010;54:541-545.
48. Amalric M, Larcher R, Brunot V, et al. Impact of Videolaryngoscopy Expertise on First-Attempt Intubation Success in Critically Ill Patients. Crit Care Med. 2020;48:889-896.
49. Jaber S, Jung B, Corne P, et al. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med. 2010;36:248-255.
50. Corl KA, Dado C, Agarwal A, et al. A modified Montpellier protocol for intubating intensive care unit patients is associated with an increase in first-pass intubation success and fewer complications. J Crit Care. 2018;44:191-195.
51. Fong KM, Au SY, Ng GWY. Preoxygenation before intubation in adult patients with acute hypoxemic respiratory failure: a network meta-analysis of randomized trials. Crit Care. 2019;23:319.
52. Weingart SD. Preoxygenation, reoxygenation, and delayed sequence intubation in the emergency department. J Emerg Med. 2011;40:661-667.
53. Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59:165-175.
54. Sakles JC, Pacheco GS, Kovacs G, et al. The difficult airway refocused. Br J Anaesth. 2020;125:18-21.
55. Hickey AJ, Cummings MJ, Short B, et al. Approach to the Physiologically Challenging Endotracheal Intubation in the Intensive Care Unit. Respir Care. 2023;68:1438 1448.
56. Ahmed A, Azim A. Difficult tracheal intubation in critically ill. J Intensive Care. 2018;6:49.
57. Russotto V, Myatra SN, Laffey JG, et al. Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients From 29 Countries. JAMA. 2021;325:1164-1172.

There are 56 citations in total.

Details

Primary Language	English
Subjects	Anaesthesiology
Journal Section	Review
Authors	Joana Berger-Estilita This is me 0000-0002-8695-4264 Ekin Köselerli This is me 0009-0002-5570-5983 Mustafa Kemal Bayar This is me 0000-0002-0506-4869 Başak Ceyda Meço 0000-0003-2951-9634
Publication Date	October 10, 2024
Submission Date	March 21, 2024
Acceptance Date	July 30, 2024
Published in Issue	Year 2024 Volume: 77 Issue: 3

Cite

APA	Berger-Estilita, J., Köselerli, E., Bayar, M. K., Meço, B. C. (2024). Challenges in Intensive Care Airway Management: A Comprehensive Review. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 77(3), 231-238. https://doi.org/10.4274/atfm.galenos.2024.16769
AMA	Berger-Estilita J, Köselerli E, Bayar MK, Meço BC. Challenges in Intensive Care Airway Management: A Comprehensive Review. Ankara Üniversitesi Tıp Fakültesi Mecmuası. October 2024;77(3):231-238. doi:10.4274/atfm.galenos.2024.16769
Chicago	Berger-Estilita, Joana, Ekin Köselerli, Mustafa Kemal Bayar, and Başak Ceyda Meço. “Challenges in Intensive Care Airway Management: A Comprehensive Review”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 77, no. 3 (October 2024): 231-38. https://doi.org/10.4274/atfm.galenos.2024.16769.
EndNote	Berger-Estilita J, Köselerli E, Bayar MK, Meço BC (October 1, 2024) Challenges in Intensive Care Airway Management: A Comprehensive Review. Ankara Üniversitesi Tıp Fakültesi Mecmuası 77 3 231–238.
IEEE	J. Berger-Estilita, E. Köselerli, M. K. Bayar, and B. C. Meço, “Challenges in Intensive Care Airway Management: A Comprehensive Review”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 77, no. 3, pp. 231–238, 2024, doi: 10.4274/atfm.galenos.2024.16769.
ISNAD	Berger-Estilita, Joana et al. “Challenges in Intensive Care Airway Management: A Comprehensive Review”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 77/3 (October2024), 231-238. https://doi.org/10.4274/atfm.galenos.2024.16769.
JAMA	Berger-Estilita J, Köselerli E, Bayar MK, Meço BC. Challenges in Intensive Care Airway Management: A Comprehensive Review. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2024;77:231–238.
MLA	Berger-Estilita, Joana et al. “Challenges in Intensive Care Airway Management: A Comprehensive Review”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, vol. 77, no. 3, 2024, pp. 231-8, doi:10.4274/atfm.galenos.2024.16769.
Vancouver	Berger-Estilita J, Köselerli E, Bayar MK, Meço BC. Challenges in Intensive Care Airway Management: A Comprehensive Review. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2024;77(3):231-8.

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