Project for Universal Management of Airways – part 1: concept and methods

Abstract

Multiple professional groups and societies worldwide have produced airway management guidelines. These are typically targeted at the process of tracheal intubation by a particular provider group in a restricted category of patients and reflect practice preferences in a particular geographical region. The existence of multiple distinct guidelines for some (but not other) closely related circumstances, increases complexity and may obscure the underlying principles that are common to all of them. This has the potential to increase cognitive load; promote the grouping of ideas in silos; impair teamwork; and ultimately compromise patient care. Development of a single set of airway management guidelines that can be applied across and beyond these domains may improve implementation; promote standardisation; and facilitate collaboration between airway practitioners from diverse backgrounds. A global multidisciplinary group of both airway operators and assistants was assembled. Over a 3-year period, a review of the existing airway guidelines and multiple reviews of the primary literature were combined with a structured process for determining expert consensus. Any discrepancies between these were analysed and reconciled. Where evidence in the literature was lacking, recommendations were made by expert consensus. Using the above process, a set of evidence-based airway management guidelines was developed in consultation with airway practitioners from a broad spectrum of disciplines and geographical locations. While consistent with the recommendations of the existing English language guidelines, these universal guidelines also incorporate the most recent concepts in airway management as well as statements on areas not widely addressed by the existing guidelines. The recommendations will be published in four parts that respectively address: airway evaluation; airway strategy;

Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*

“…This guideline is intended for use by appropriately trained airway practitioners [ 32 ]. It does not represent international standards but consensus guidance.…”

Tracheal Intubation in Emergency Departments in China: A National Cross-Sectional Survey

“…Although this study did not delve into the reasons for the lack of sedative and muscle relaxant medications being used in ED intubations, a lack of standardized training or a lack of medication in the ED may be the cause. Airway guidelines have recently been updated in the anesthesiology and emergency medicine fields (13), but, as is the case in many countries, clinical physicians are slow to change their practice.…”

The 2004 Difficult Airway Society guidelines for the management of difficult tracheal intubation: revolutionary and enduring

“…Perhaps among this proliferation of guidelines there is concern that there are too many options and variations, most commonly based around national and specialty boundaries. This has led to the recent PUMA initiative aspiring to develop universal guidelines and, as a first step to that, the publication of universal principles [29]. While there is a coherent argument that the international airway community should be able to reach universal conclusions from a given set of evidence, in the same manner that the resuscitation community has, only time will tell if such a project and product is achievable.…”