• Severe hypothermia causes grave disorders of respiratory system. Major decrease in body temperature causes disturbance of brain function, depression of respiratory centre in brain stem and impairment of defence reflexes of the airways [1].

• Severe stages of hypothermia are associated with increasing stiffness in skeletal muscles, what may cause difficulties in airways management [2]. The rescuer must be ready to face difficulties in tilting the head of the patient, limited degree to which mouth of the patient opens during insertion of oropharyngeal airway (OP), laryngeal mask airway (LMA) or laryngoscopy [3].

• Because of low incidence rate of hypothermia it cannot be unequivocally stated that hypothermic patients constitute a group of patients with expected difficulties in intubation, yet such statement may fi nd grounds in pathophysiology of the disorder [2, 4].

• Hypothermic patients who are unconscious or in cardiac arrest constitute the group particularly threatened by aspiration of gastric contents. Passive movement of gastric contents to larynx (regurgitation) is a dangerous complication, which may lead both to mechanical obstruction of the airways as well as aspiration (chemical) pneumonitis [3]. In physiological conditions the stomach is emptied within 6 hours. Hypothermia may prolong this process.

• Stiffness of skeletal muscles increasing with hypothermia may cause decrease in chest compliance and lead to ventilation disorders. Reduced elasticity of chest walls may favour occurrence of atelectasis, disorders of ventilation/perfusion ratio (V/Q ratio) and pulmonary shunt [2, 5]. Lowered partial pressure of oxygen in blood may result.

• Settings where medical care is provided (prehospital setting, emergency ward) and competence of providers are important factors that determine scope of airway management.