CICO recognition: When oxygenation is failing before it fails
cico oxygenation recognition ventilation Jan 12, 2026
CICO RECOGNITION: WHEN OXYGENATION IS FAILING BEFORE IT FAILS
Airway crises rarely announce themselves clearly. In perianaesthesia care, deterioration often begins quietly, long before the monitor alarms or saturations fall. CICO is not a sudden event. It is usually the end point of a series of missed cues, delayed decisions, and ongoing upper airway attempts that are no longer helping.
Oxygenation depends on ventilation first. When ventilation becomes ineffective, oxygen reserves are consumed rapidly, especially in patients with limited physiological reserve. Reduced chest movement, poor bag compliance, absent or diminishing capnography, and increasing airway pressures all signal that gas is no longer moving effectively, even if SpO₂ still appears acceptable. This window is short and deceptive.
Key early indicators matter because waiting for desaturation means waiting too long.
🔹 Poor or absent capnography despite apparent airway positioning
🔹 Increasing difficulty with mask ventilation or supraglottic airway seal
🔹 Rising airway pressures with minimal chest rise
🔹 Repeated airway attempts without improvement in ventilation
🔹 Cognitive fixation on upper airway techniques despite failure
Recognising these signs allows the team to reframe the situation early. The focus shifts from “trying one more thing” to restoring oxygen delivery by the most reliable means available. This is where clear declaration, role clarity, and preparation for front of neck access become protective actions rather than last resorts.
For perianaesthesia nurses, early CICO recognition means speaking up when ventilation is not effective, not waiting for numbers to confirm what physiology already shows. Early escalation preserves time, oxygen, and neurological outcomes. Oxygenation failure is predictable. The skill lies in seeing it before it becomes irreversible.
References
Chrimes, N., et al. (2020). Lost in transition: the challenges of getting airway clinicians to move from the upper airway to the neck during an airway crisis. British Journal of Anaesthesia.
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