Airway management in the critically ill patient is a challenging task, with an estimated 45% risk of adverse events. Cardiovascular collapse (defined in most studies as a systolic pressure <65 mmHg at least once, or 90 mmHg for >30 min; or the need to start or increase vasopressor drugs or treat with rescue i.v. fluids) is observed in up to 43% of procedures. Severe hypoxaemia (Spo2 <80%) is reported in 9%, and cardiac arrest reported in 3% of procedures.1 Failure to achieve first-pass tracheal intubation significantly increases the risks after intubation, and patients who sustain a major adverse event after intubation are at higher risk of both intensive care unit (ICU) (adjusted odds ratio [aOR] 1.52, 95% confidence interval [95% CI] 1.26–1.83); and 28-day mortality (aOR 1.44, 95% CI 1.19–1.74).

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