A patient previously identified as a difficult intubation in the past may not easily be intubated by direct laryngoscopy, and enlisting the help of an anesthesiologist if the patient requires airway management may prevent complications. It is also important to keep in mind that a patient who requires reintubation postoperatively may have developed airway edema or laryngospasm that may complicate intubation. Reintubation may also be difficult if the patient has undergone surgery involving or close to the airway (cervical fusion, thyroidectomy, carotid endarterectomy) or has received large volumes of intravenous fluids or blood products that could lead to airway edema.

ICU patients in respiratory distress or failure often have decreased respiratory reserve and may be hypoxic. These patients desaturate much more quickly during airway management, so preoxygenation is critical, and the amount of time to safely secure the airway might be diminished. This is especially common in patients with obstructive sleep apnea or patients requiring continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) to maintain oxygenation. In these patients, if difficulty with mask ventilation or intubation is suspected, contacting your airway professional for assistance prior to intervention may be prudent. It may also be safer to secure the airway early, and in a controlled fashion, prior to the development of acute respiratory distress or failure.

Access to the patient for airway management in the ICU is often more difficult than in the operating room because of the smaller size
of the room. Many cables and plugs are connected to an ICU bed and additional monitors or intravenous pumps may limit access to the head of the bed for airway manipulation; space for additional airway equipment may be limited. It may also be difficult for additional personnel to access the patient, for instance, if a cricothyroidotomy or tracheostomy needs to be performed. This can increase the challenge of difficult airway management.