Report of the NAP4 Airway Project

Major complications related to airway management over a 12-month period were reported and examined by an expert panel in the Royal College of Anaesthetists' fourth National Audit Project. Thirty-six reports originated in the intensive care unit, just under 20% of all reports, but resulted in 60% of deaths or significant neurological injury of all cases examined. Cases could be broadly divided into: failed or unrecognised oesophageal intubation; airway displacement; haemorrhage; airway problems during patient transfer; and other. Capnography was not used routinely and contributed to delayed recognition of airway problems. Staff managing complex airways did not always have advanced airway skills. Equipment and back-up planning was frequently deficient. The panel have made recommendations to attempt to improve airway management in the intensive care environment. This article is a précis of two chapters (chapter 9, Intensive care; and chapter 15, Major airway events in patients with a tracheostomy) in the NAP4 audit report. The complete report is available as referenced below. 1 The British Journal of Anaesthesia has also published a report of airway events in intensive care and emergency departments from NAP4. 2