{"title":"Guideline recommendations on the assessment and management of awake airway intubation: a systematic review.","authors":"Fei Chen, Zhimin Tan, Qiyu He, Qian Li","doi":"10.1186/s12871-025-02940-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To systematically appraise the quality of clinical practice guidelines (CPGs) regarding awake tracheal intubation (ATI) and to compare the consistency of common recommendations.</p><p><strong>Design: </strong>Systematic review, critical appraisal and narrative synthesis of CPG recommendations for ATI.</p><p><strong>Methods: </strong>A systematic search of the PubMed, EMBASE, Cochrane, Web of Science, and Scopus databases was conducted up to July 1, 2024, to identify up-to-date CPGs. The AGREE II (Appraisal of Guidelines for Research and Evaluation) checklist was used to critically appraise the CPGs. Interrater agreement was determined via intraclass correlation coefficients (ICCs) with a two-way random effects model for each domain and overall rating score. All the suggestions extracted from the included guidelines were sorted and analyzed and summarized via the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.</p><p><strong>Results: </strong>Our study resulted in 939 records and ultimately 7 CPGs were appraised. The content of these CPGs covered six themes of ATI: indications, airway local anesthesia, the intubation procedure, checking the tube position, management after ATI failure, and the extubation process. When the AGREE II tool was used to appraise CPGs, only 3 CPGs were rated as \"high\" quality. With the exception of domain 1, we observed good agreement in all five other domains (ICCs over 0.7). These CPGs provided relatively consistent recommendations and evidence on intubation procedures and checking tube position. In terms of indications and airway local anesthesia, there was controversy. Twenty-nine recommendations regarding ATI were summarized through the GRADE system, among which 16 were considered relatively reliable.</p><p><strong>Conclusion: </strong>Through the AGREE II tool and the GRADE system, the strengths and weaknesses of each CPG were comprehensively analyzed on the basis of its scientific validity and practicability. Moreover, the limitations of the current CPGs in terms of indications, airway local anesthesia and complex clinical situations are presented, and clinicians are encouraged to apply the guidelines more scientifically and to update and improve the guidelines.</p><p><strong>Systematic review registration: </strong>CRD4202458548 (PROSPERO).</p>","PeriodicalId":9190,"journal":{"name":"BMC Anesthesiology","volume":"25 1","pages":"79"},"PeriodicalIF":2.3000,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834173/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Anesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12871-025-02940-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: To systematically appraise the quality of clinical practice guidelines (CPGs) regarding awake tracheal intubation (ATI) and to compare the consistency of common recommendations.
Design: Systematic review, critical appraisal and narrative synthesis of CPG recommendations for ATI.
Methods: A systematic search of the PubMed, EMBASE, Cochrane, Web of Science, and Scopus databases was conducted up to July 1, 2024, to identify up-to-date CPGs. The AGREE II (Appraisal of Guidelines for Research and Evaluation) checklist was used to critically appraise the CPGs. Interrater agreement was determined via intraclass correlation coefficients (ICCs) with a two-way random effects model for each domain and overall rating score. All the suggestions extracted from the included guidelines were sorted and analyzed and summarized via the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.
Results: Our study resulted in 939 records and ultimately 7 CPGs were appraised. The content of these CPGs covered six themes of ATI: indications, airway local anesthesia, the intubation procedure, checking the tube position, management after ATI failure, and the extubation process. When the AGREE II tool was used to appraise CPGs, only 3 CPGs were rated as "high" quality. With the exception of domain 1, we observed good agreement in all five other domains (ICCs over 0.7). These CPGs provided relatively consistent recommendations and evidence on intubation procedures and checking tube position. In terms of indications and airway local anesthesia, there was controversy. Twenty-nine recommendations regarding ATI were summarized through the GRADE system, among which 16 were considered relatively reliable.
Conclusion: Through the AGREE II tool and the GRADE system, the strengths and weaknesses of each CPG were comprehensively analyzed on the basis of its scientific validity and practicability. Moreover, the limitations of the current CPGs in terms of indications, airway local anesthesia and complex clinical situations are presented, and clinicians are encouraged to apply the guidelines more scientifically and to update and improve the guidelines.
目的：系统评价清醒气管插管（ATI）临床实践指南（CPGs）的质量，并比较常见建议的一致性。设计：系统回顾，批判性评估和叙述综合CPG对ATI的建议。方法：系统检索截至2024年7月1日的PubMed、EMBASE、Cochrane、Web of Science和Scopus数据库，以确定最新的cpg。研究和评估指南评估（AGREE II）检查表用于对CPGs进行严格评估。通过类内相关系数（ICCs）和每个领域的双向随机效应模型和总体评分来确定评分者之间的一致性。通过GRADE （Grading of Recommendations Assessment, Development and Evaluation）系统对从纳入指南中提取的所有建议进行分类、分析和总结。结果：本研究共获得939条记录，最终评价了7个cpg。这些CPGs的内容涵盖了ATI的六个主题：适应证、气道局部麻醉、插管程序、检查管位、ATI失败后的处理和拔管过程。当使用AGREE II工具评估cpg时，只有3个cpg被评为“高”质量。除领域1外，我们观察到其他五个领域的一致性都很好（ICCs大于0.7）。这些CPGs在插管程序和检查管位方面提供了相对一致的建议和证据。在适应证和气道局部麻醉方面，存在争议。通过GRADE系统总结了关于ATI的29条建议，其中16条被认为是相对可靠的。结论：通过AGREE II工具和GRADE系统，综合分析各CPG的优势和劣势，在其科学有效性和实用性的基础上。同时指出了现行CPGs在适应证、气道局部麻醉和复杂临床情况等方面的局限性，鼓励临床医生更加科学地应用指南，并不断更新和完善指南。系统评价注册：CRD4202458548 （PROSPERO）。
期刊介绍：
BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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