Evidence map›Paper›PMID 39162823›Full record

ArticleIntensive care medicine2024

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

Kunal Karamchandani, Prashant Nasa, Mary Jarzebowski, David J Brewster, Audrey De Jong, Philippe R Bauer, Lauren Berkow, Calvin A Brown, Luca Cabrini, Jonathan Casey and 33 more

Abstract read
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In one paragraph

Article in Intensive care medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 3 pooled it
–field-weighted citation impact
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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Guideline
  3. Guideline
  4. Trial
  5. Review
  6. From the Oracle of Delphi to Intensive Care Unit Guidelines: Consensus Building Using the Delphi Method.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026
    Article
  7. Curriculum for Airway Skills in Critically Ill Adults: Protocol for a Delphi Evaluation (CASCADE).Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026
    Article
  8. Review
  9. Article
  10. Review
  11. Article
  12. Review
  13. Observational
  14. Review
  15. Ten tips for a safe approach in airway management.Journal of anesthesia, analgesia and critical care · 2026
    Review
  16. Article
  17. Article
  18. Review
  19. The Pharmacology of Physiologically Difficult Airway Management and Impact on Hemodynamics: A Review.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026
    Review
  20. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

43 authors.

Kunal KaramchandaniDepartment of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA. kunal.karamchandani@utsouthwestern.edu.ORCID 0000-0003-3089-8088
Prashant NasaCritical Care Medicine, NMC Specialty Hospital, Al Nahda, Dubai, UAE.
Mary JarzebowskiDepartment of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Health, Detroit, MI, USA.
David J BrewsterIntensive Care Unit, Cabrini Hospital, Melbourne, Australia.
Audrey De JongDepartment of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Phymedexp, Université de Montpellier, Inserm, CNRS, CHRU de Montpellier, Montpellier, France.
Philippe R BauerDivision of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA.
Lauren BerkowDepartment of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA.
Calvin A BrownDepartment of Emergency Medicine, Lahey Hospital and Medical Center, UMass Chan - Lahey School of Medicine, Burlington, MA, USA.
Luca CabriniDepartment of Biotechnology and Life Sciences, Insubria University, Ospedale di Circolo, Varese, Italy.
Jonathan CaseyDivision of Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA.
Tim CookDepartment of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
Jigeeshu Vasishtha DivatiaDepartment of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Laura V DugganDepartment of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada.
Louise EllardDepartment of Critical Care, University of Melbourne, Department of Anaesthesia, Austin Health, Victoria, Australia.
Begum ErganDivision of Critical Care Medicine, Department of Pulmonary and Critical Care, Dokuz Eylul University, Izmir, Turkey.
Malin Jonsson FagerlundDepartment of Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska University Hospital Solna and Karolinska Institutet, Stockholm, Sweden.
Jonathan GatwardIntensive Care Unit, Royal North Shore Hospital, Sydney, Australia.
Robert GreifUniversity of Bern, Bern, Switzerland.
Andy HiggsDepartment of Critical Care Medicine, Warrington Teaching Hospitals, Cheshire, UK.
Samir JaberDepartment of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, Phymedexp, Université de Montpellier, Inserm, CNRS, CHRU de Montpellier, Montpellier, France.
David JanzSection of Pulmonary and Critical Care Medicine, Tulane School of Medicine, University Medical Center New Orleans, LSU School of Medicine of New Orleans, New Orleans, LA, USA.
Aaron M JoffeDepartment of Anesthesiology, Creighton University School of Medicine, Valleywise Health Medical Center, Phoenix, AZ, USA.
Boris JungMedical Intensive Care Unit, INSERM PhyMedexp, Montpellier University, Montpellier, France.
George KovacsDepartments of Emergency Medicine, Anaesthesia, Medical Neurosciences & Continuing Professional Development and Medical Education, Charles V. Keating Emergency and Trauma Centre, Dalhousie University, Halifax, NS, Canada.
Arthur KwizeraDepartment of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Mulago Hospital Complex, Kampala, Uganda.
John G LaffeyDepartment of Anaesthesia and Intensive Care Medicine, Galway University Hospital, Saolta Hospital Group, Galway, Ireland.
Jean-Baptiste LascarrouNantes Université, CHU Nantes, Movement - Interactions - Performance, MIP, Médecine Intensive Réanimation, UR 4334, 44000, Nantes, France.
J Adam LawDepartment of Anesthesia, Pain Management and Perioperative Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
Stuart MarshallDepartment of Critical Care, University of Melbourne, Melbourne, Australia.
Brendan A McGrathAnaesthesia and Intensive Care Medicine, Manchester University Hospital, NHS Foundation Trust, Manchester, UK.
Jarrod M MosierDepartment of Emergency Medicine, Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep, University of Arizona College of Medicine, Tucson, AZ, USA.
Daniel PerinAlbert Einstein Hospital, São Paulo, Brazil.
Oriol RocaServei de Medicina Intensiva, Institut de Recerca Part Taulí (I3PT-CERCA), Parc Taulí Hospital Universitari, Sabadell, Spain.
Amélie RolléAnesthesia and Intensive Care, University Hospital of La Guadeloupe, University of Les Antilles, Abymes, France.
Vincenzo RussottoAnesthesia and Intensive Care, University Hospital San Luigi Gonzaga, Orbassano (TO), University of Turin, Turin, Italy.
John C SaklesDepartment of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, USA.
Gentle S ShresthaDepartment of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
Nathan J SmischneyDepartment of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
Massimiliano SorbelloUOC Anesthesia and Intensive Care PO Giovanni Paolo II, Ragusa, Italy.
Avery TungDepartment of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA.
Craig S JabaleyDepartment of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.
Sheila Nainan MyatraDepartment of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Society of Critical Care Anesthesiologists (SOCCA) Physiologically Difficult Airway Task Force

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeOur study aimed to provide consensus and expert clinical practice statements related to airway management in critically ill adults with a physiologically difficult airway (PDA).

methodsAn 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.

resultsThe 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.

conclusionUsing 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.

Indexed as

Airway ManagementCritical IllnessDelphi TechniqueIntubation, IntratrachealAdultConsensusCritical CareHumansLaryngoscopyAirway managementDelphiGuidelinesIntratracheal/adverse effectsIntratracheal/methodsIntubationPhysiologically difficult airwayTracheal intubation

Identifiers

PMID39162823

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.