Tracheal intubation in critically ill adults with a physiologically difficult airway. An international Delphi study

Kunal Karamchandani, University of Texas Southwestern Medical Center, Dallas, TX
Prashant Nasa, NMC Specialty Hospital, Al Nahda, Dubai, United Arab Emirates
Mary Jarzebowski, Henry Ford Health, Detroit, MI
David J. Brewster, Cabrini Hospital, Melbourne, Australia
Audrey De Jong, University of Montpellier, France
Philippe R. Bauer, Mayo Clinic, Rochester, MN
Lauren Berkow, University of Florida College of Medicine, Gainesville, FL
Calvin A. Brown, UMass Chan - Lahey School of Medicine, Burlington, MA
Luca Cabrini, Insubria University, Ospedale di Circolo, Varese, Italy
Jonathan Casey, Vanderbilt University Medical Center, Nashville, TN
Tim Cook, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
Jigeeshu Vasishtha Divatia, Homi Bhabha National Institute, Mumbai, India
Laura V. Duggan, University of Ottawa, Canada
Louise Ellard, University of Melbourne, Australia
Begum Ergan, Dokuz Eylul University, Izmir, Turkey
Malin Jonsson Fagerlund, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden
Jonathan Gatward, Royal North Shore Hospital, Sydney, Australia
Robert Greif, University of Bern, Switzerland
Andy Higgs, Warrington Teaching Hospitals, Cheshire, UK
Samir Jaber, University of Montpellier, France
David Janz, LSU Health Sciences Center - New OrleansFollow
Aaron M. Joffe, Creighton University School of Medicine, Phoenix, AZ
Boris Jung, Montpellier University, France
George Kovacs, Dalhousie University, Halifax, NS, Canada
Arthur Kwizera, Makerere University College of Health Sciences, Kampala, Uganda
John G. Laffey, Galway University Hospital, Galway, Ireland
Jean-Baptiste Lascarrou, Nantes Université, Nantes, France
et al

Document Type

Article

Publication Date

8-20-2024

Publication Title

Intensive Care Medicine

Abstract

Purpose: Our study aimed to provide consensus and expert clinical practice statements related to airway management in critically ill adults with a physiologically difficult airway (PDA). Methods: An international Steering Committee involving seven intensivists and one Delphi methodology expert was convened by the Society of Critical Care Anaesthesiologists (SOCCA) Physiologically Difficult Airway Task Force. The committee selected an international panel of 35 expert clinician–researchers with expertise in airway management in critically ill adults. A Delphi process based on an iterative approach was used to obtain the final consensus statements. Results: The Delphi process included seven survey rounds. A stable consensus was achieved for 53 (87%) out of 61 statements. The experts agreed that in addition to pathophysiological conditions, physiological alterations associated with pregnancy and obesity also constitute a physiologically difficult airway. They suggested having an intubation team consisting of at least three healthcare providers including two airway operators, implementing an appropriately designed checklist, and optimizing hemodynamics prior to tracheal intubation. Similarly, the experts agreed on the head elevated laryngoscopic position, routine use of videolaryngoscopy during the first attempt, preoxygenation with non-invasive ventilation, careful mask ventilation during the apneic phase, and attention to cardiorespiratory status for post-intubation care. Conclusion: Using a Delphi method, agreement among a panel of international experts was reached for 53 statements providing guidance to clinicians worldwide on safe tracheal intubation practices in patients with a physiologically difficult airway to help improve patient outcomes. Well-designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.

PubMed ID

39162823

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