The incidence and survival of patients with head-and-neck cancer have been on the increase for decades. Following surgery or radiation therapy, complications such as difficult airways may evolve. These difficult airways may be unique and not manageable with conventional intubation methods as well as video laryngoscopes. Acute awake fiberoptic intubation may be a feasible option also for urgent emergency airway management of known difficult airways. The "cannot intubate-cannot oxygenate" (CI-CO) situation has to be avoided at all costs, since emergency cricothyrotomy has a fail ratio of more than 50% when performed by an anesthesiologist.

High-flow nasal oxygen therapy warms and humidifies gases, allows better clearance of secretions, along with providing added benefits like preventing dehydration of airway surface, while decreasing atelectasis and thereby, offering comfort to the patient. While its effect on critically ill patients is still in its pioneering phase, there is lack of substantial evidence on the use of high-flow nasal cannula in cardiac patients with type I respiratory failure. We found it worthwhile to share our experience of its use in elderly and postpartum patients with moderate-to-severe pulmonary hypertension, with associated comorbidities and type I respiratory failure, with do-not-intubate or defer intubation status. In patients with pulmonary hypertension (PHT) and respiratory failure, endotracheal intubation followed by initiation of mechanical ventilation may have detrimental hemodynamic effects. Increase in lung volumes and decrease in functional residual capacity lead to increase in pulmonary hypertension and right ventricle afterload. If a patient has right heart failure, lung hyperinflation can fatally reduce cardiac output. High-flow nasal oxygen therapy may be of an advantage in these scenarios. How to cite this article: Gupta B, Kerai S, Kakkar K, Gupta L. Role of High-flow Nasal Oxygen Therapy in Cases with Pulmonary Hypertension in an Intensive Care Unit Setting. Indian J Crit Care Med 2019;23(10):458-461.

The addition of a do-not-operate (DNO) section to current medical orders for life-sustaining treatment (MOLST) and physician orders for life-sustaining treatment (POLST) medical order forms would more completely document patients' wishes for invasive interventions at the end of life. We propose a modification of the MOLST and POLST forms, in addition to hospital and electronic medical records, to include a DNO section, in addition to preexisting do-not-resuscitate (DNR) and do-not-intubate (DNI) orders, with the goal of reducing suffering from nonbeneficial surgical interventions in patients with severe illness at the end of life.

It is unclear how the recent local and international focus on systems issues and human factors in 'can't intubate, can't oxygenate' events has impacted institutional preparedness in Australia and New Zealand. This study attempts to capture a snapshot of current practices in Australian and New Zealand teaching hospitals with regard to preparedness to prevent and manage 'can't intubate, can't oxygenate' events. All Australian and New Zealand College of Anaesthetists' teaching hospitals were invited to complete an online survey consisting of 33 questions on terminology, equipment, cognitive aids, training and quality assurance. Follow-up was by both email and telephone. Responses were received from 129 (91%) of the 142 sites. The survey revealed both countries have largely moved to point-of-care 'can't intubate, can't oxygenate' equipment. There were regional differences reported, with Australia favouring equipment, cognitive aids and teaching that supports a combined cannula and scalpel approach to 'can't intubate, can't oxygenate', whilst New Zealand favours those promoting a scalpel-only approach. A lack of consistency with the terminology used around 'can't intubate, can't oxygenate' both within and between the two countries was also identified. This survey has revealed a generally reassuringly high degree of institutional preparedness to prevent and manage 'can't intubate, can't oxygenate' events across both countries but with strong regional differences in approaches. Little is known of the institutional practices outside these countries, making international comparison difficult.