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

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发表日期：

2024年8月20日

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Kunal Karamchandani,
Prashant Nasa,
Mary Jarzebowski,
David J. Brewster,
Audrey De Jong,
Philippe R. Bauer,
Lauren Berkow,
Calvin A. Brown III,
Luca Cabrini,
Jonathan Casey,
Tim Cook,
Jigeeshu Vasishtha Divatia,
Laura V. Duggan,
Louise Ellard,
Begum Ergan,
Malin Jonsson Fagerlund,
Jonathan Gatward,
Robert Greif,
Andy Higgs,
Samir Jaber,
David Janz,
Aaron M. Joffe,
Boris Jung,
George Kovacs,
Arthur Kwizera,
John G. Laffey,
Jean-Baptiste Lascarrou,
J. Adam Law,
Stuart Marshall,
Brendan A. McGrath,
Jarrod M. Mosier,
Daniel Perin,
Oriol Roca,
Amélie Rollé,
Vincenzo Russotto,
John C. Sakles,
Gentle S. Shrestha,
Nathan J. Smischney,
Massimiliano Sorbello,
Avery Tung,
Craig S. Jabaley,
Sheila Nainan Myatra,
Kariem El-Boghdadly,
Anna Budde,
Stephen Estime,
Kristina Goff,
Rachel Kadar,
Ashish K. Khanna,
Crystal Manohar,
Gerald Matchett,
Ronald G. Pearl,
Robert D. Stevens,
Habib Srour

摘要

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.