BEFORE THE FIRST ATTEMPT: THE IMPORTANCE OF A CHECKLIST FOR INTUBATION IN CRITICALLY ILL PATIENTS

Tracheal intubation in critically ill adults carries a risk of hypoxaemia and haemodynamic deterioration. Even technically successful intubation may be accompanied by severe physiological instability. Safe airway management therefore requires preparation, assessment of both anatomical and physiological risks, and coordinated teamwork. This presentation describes a case-based educational strategy using a Georgian translation of the preintubation checklist developed by the Difficult Airway Society, Intensive Care Society, Faculty of Intensive Care Medicine, and Royal College of Anaesthetists (DAS/ICS/FICM/RCoA). Its aim is to demonstrate how the checklist can structure clinical decision-making and team communication before the first intubation attempt. The educational approach follows the checklist’s four domains: preparation of the patient, preparation of equipment, preparation of the team, and preparation for difficulty. A clinical scenario is used to discuss preoxygenation, cardiovascular optimisation, induction tailored to the patient’s physiology, and postintubation management. Checklist items are linked to relevant evidence from clinical guidelines and studies, with emphasis on role allocation and a shared plan for difficult or failed intubation. The checklist is presented as a practical framework for identifying potential omissions, establishing a shared airway plan, and preparing for complications. Its central educational message is that maintaining oxygenation and perfusion throughout airway management is essential, alongside successful placement of the tracheal tube. The presentation proposes a structured approach to teaching preparation for intubation in critically ill adults.