Securing the Airway, Protecting the Brain: Neuroprotective Intubation for Acute Neurologic Emergencies.

Emergency airway management in acute brain injury carries unique physiologic risks, such as hypotension, hypoxia, hypercarbia, and sympathetic surges can precipitate secondary brain injury. This review outlines a neuroprotective approach focused on deliberate preparation, physiologic optimization, and evidence-informed techniques. Key elements include rapid ABCD assessment, recognition of elevated intracranial pressure, appropriate use of hyperosmolar therapy, strategies to blunt sympathetic surges, tailored induction and paralysis, techniques to maximize first-pass success, and postintubation ventilation and sedation aimed at maintaining eucapnia, normoxia, and stable cerebral perfusion. This approach reframes intubation as an opportunity to prevent secondary injury and improve outcomes.