81. Advanced Airway Management & Awake Intubation with Dr. Jarrod Mosier

Managing the physiologically difficult airway requires prioritizing patient stability over the convenience of standard rapid sequence intubation. These airways are defined by cardiopulmonary complexities—such as severe hypoxemia, hypotension, or metabolic acidosis—that render patients intolerant to the apnea induced by traditional procedures. Awake intubation offers a safer alternative by maintaining spontaneous respiration, provided the clinician masters meticulous topicalization techniques. Using atomized lidocaine—not nebulized—and ensuring proper patient coaching are essential for success. Dr. Jarrod Mosier, an intensivist and airway expert, highlights that clinicians often fall victim to cognitive biases like the affect heuristic, choosing familiar but risky methods over safer, albeit less practiced, techniques. Mastering awake intubation and fostering a culture where team members feel empowered to suggest it are vital for managing high-acuity, low-occurrence airway challenges effectively.