Evidence map›Paper›PMID 31729018›Full record

GuidelineAnaesthesia2020

Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults.

I Ahmad, K El-Boghdadly, R Bhagrath, I Hodzovic, A F McNarry, F Mir, E P O'Sullivan, A Patel, M Stacey, D Vaughan

Registry-linked trialOpen access · hybridAbstract readPractice Guideline
PubMed Full text at PMC Publisher
In one paragraph

Guideline in Anaesthesia, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06026566 (Compatible Dose Study and Effect Observation of Remimazolam Besylate Combined With Afentanil for Awake Endotracheal Intubation), which is not on this map. Cited by 203 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
203citing papers in PubMed, 11 pooled it
56.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06026566 naunknown statusnot on this mapstarted 2023, after this paper: background citation

Compatible Dose Study and Effect Observation of Remimazolam Besylate Combined With Afentanil for Awake Endotracheal Intubation

TypeinterventionalSponsorTongji HospitalRan2023 to 2025Enrolled180ConditionsRemimazolam, Awake Endotracheal IntubationArmsDos of Afentanil 20, Dos of Afentanil 30, Dos of Afentanil 40, Dos of Afentanil 50, Dos of Afentanil 60
3 · Its place in the literature

Who cites it

203 citing papers in PubMed, 11 syntheses or guidelines pooled it, 489 citations in OpenAlex.

  1. Guideline
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  11. Pooled it
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  19. Vie Scope® versus videolaryngoscopy in expected difficult airways: a randomized controlled trial.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2023
    Trial
  20. Trial

143 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 9 institutions in 2 countries.

I AhmadDepartment of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.
K El-BoghdadlyDepartment of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK.
R BhagrathDepartment of Anaesthesia, Barts Health NHS Trust, London, UK.
I HodzovicDepartment of Anaesthesia, Cardiff University School of Medicine, Cardiff, UK.
A F McNarryDepartment of Anaesthesia, NHS Lothian, Edinburgh, UK.
F MirDepartment of Anaesthesia, St. George's University Hospital NHS Foundation Trust, London, UK.
E P O'SullivanDepartment of Anaesthesia, St James's Hospital, Dublin, Ireland.
A PatelDepartment of Anaesthesia, Royal National Throat Nose and Ear Hospital and University College London Hospitals NHS Foundation Trust, London, UK.
M StaceyDepartment of Anaesthesia, Cardiff and Vale NHS Trust (HEIW), Cardiff, UK.
D VaughanDepartment of Anaesthesia, Northwick Park Hospital, London, UK.
King's College London · GBAneurin Bevan University Health Board · GBBarts Health NHS Trust · GBCardiff and Vale University Health Board · GBNHS Lothian · GBNorthwick Park Hospital · GBRoyal National Throat Nose and Ear Hospital · GBSt George’s University Hospitals NHS Foundation Trust · GBSt. James's Hospital · IE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Awake tracheal intubation has a high success rate and a favourable safety profile but is underused in cases of anticipated difficult airway management. These guidelines are a comprehensive document to support decision making, preparation and practical performance of awake tracheal intubation. We performed a systematic review of the literature seeking all of the available evidence for each element of awake tracheal intubation in order to make recommendations. In the absence of high-quality evidence, expert consensus and a Delphi study were used to formulate recommendations. We highlight key areas of awake tracheal intubation in which specific recommendations were made, which included: indications; procedural setup; checklists; oxygenation; airway topicalisation; sedation; verification of tracheal tube position; complications; management of unsuccessful awake tracheal intubation; post-tracheal intubation management; consent; and training. We recognise that there are a range of techniques and regimens that may be effective and one such example technique is included. Breaking down the key practical elements of awake tracheal intubation into sedation, topicalisation, oxygenation and performance might help practitioners to plan, perform and address complications. These guidelines aim to support clinical practice and help lower the threshold for performing awake tracheal intubation when indicated.

Indexed as

AdultHumansIntubation, IntratrachealSocieties, MedicalWakefulnessairway managementbronchoscopylaryngoscopytracheal intubationtrainingvideolaryngoscopy

Identifiers

PMID31729018
PMCPMC7078877
OpenAlexW2988494116

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.