Disrupted face or neck anatomy

If managing an isolated injury that disrupts face or neck anatomy, healthy adults may only need a mechanical airway placed and may not require assisted ventilation if they are not heavily sedated. Examples of conditions requiring early airway management include:

- Massive facial trauma
- Burns to the face or inhalation injury with hoarseness or stridor
- Massive neck trauma
- Expanding neck mass/hematoma
- Acute pharyngeal infection (Retropharyngeal abscess, peritonsillar abscess, epiglottitis)
- Foreign body aspiration
- Anaphylaxis (airway swelling)

Insufficient oxygenation or ventilation

These indications may be apparent on initial evaluation or may emerge during the course of patient management. If the need to establish an airway develops more gradually, additional elective airway techniques can be employed. Interventions such as prolonged manual bag or mechanical ventilation require an airway intervention to ensure best overall management. Examples include:

- Chest wall and pulmonary trauma (blunt or penetrating) such as flail segments, pulmonary contusions (from blast, blunt or crush mechanism)
- Burns with greater than 40% body surface area
- Traumatic brain injury with decreased level of consciousness (GCS ≤ 8)
- Traumatic brain injury with suspected herniation requiring hyperventilation (target ETCO2 between 30 and 35)
- Procedural sedation or surgical procedure
- Respiratory failure from disease, infection, or injury:
  - Chemical or toxic inhalation injuries
  - Acute Respiratory Distress Syndrome (ARDS) from infection, massive resuscitation, drug-induced or other causes
  - Primary lung infection (pneumonia)
  - Massive pulmonary embolism
  - TRALI (transfusion related acute lung injury) or TACO (transfusion associated circulatory overload) due to massive transfusion