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Patient Safety and Quality Improvement

(141) Difficult Airway Management: An Appraisal of Clinical Practice Guidelines

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Deepak Lakshmipathy, BS

    Clinical Research Fellow
    University of Pennsylvania
    Fremont, California, United States

    • Co-Author(s)

  • CF

    Christian G. Fritz, MD

    Fellow
    University of Pennsylvania
    Philadelphia, Pennsylvania, United States

    • Co-Author(s)

  • SM

    Stylianos D. Monos, BA

    Medical Student
    Lewis Katz School of Medicine at Temple University
    Merion Station, PA, USA

  • JN

    Jinggang Ng, MA

    Perelman School of Medicine, University of Pennsylvania, USA

  • DR

    Dominic Romeo, MS

    Student
    Perelman School of Medicine, University of Pennsylvania
    Philadelphia, PA, United States

  • Katherine E. Xu, BS

    Medical Student
    Perelman School of Medicine At the University of Pennsylvania
    Philadelphia, Pennsylvania, United States

  • AM

    Alvaro G. Moreira, MD

    Assistant Professor
    Department of Pediatrics, University of Texas Health Science Center at San Antonio, USA

    • Senior Author(s)

  • Karthik Rajasekaran, MD

    Assistant Professor, Head and Neck Oncologic & Reconstructive Surgeon, Director of QI
    Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
    Philadelphia, Pennsylvania, United States

Disclosure(s):
Christian G. Fritz, MD: No relevant relationships to disclose.
Katherine E. Xu, BS: No relevant relationships to disclose.
Karthik Rajasekaran, MD: No relevant relationships to disclose.


Introduction: Management of the difficult airway can be a challenging process, which necessitates actionable recommendations from well-established guidelines. Herein, clinical practice guideline (CPG) quality is evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.

Methods: A systematic literature search was performed. Data were abstracted from relevant guidelines and appraised by four independent reviewers in the six domains of quality defined by the AGREE II. Intraclass correlation coefficients (ICC) were calculated across domains to quantify interrater reliability.

Results: Twelve guidelines met inclusion criteria. Eight guidelines achieved ‘high’ quality designations, with scores of >60% in five or more AGREE II quality domains. Low quality content was observed in CPGs authored by the Japanese Society of Anesthesiologists (JSA) and Chinese Collaboration Group for Emergency Airway Management (CCGEAM). Overall, deficits were most pronounced in domains describing involvement of stakeholders, developmental rigor, and editorial independence.

Conclusions: A comprehensive appraisal process revealed the highest proportion of guidelines with ‘high’ quality content ever reported using the AGREE II instrument. Although this does suggest that difficult airway management guidelines are exceptionally well-developed, the 2022 American Society of Anesthesiologists guideline objectively outperforms its predecessors with respect to the domains of quality assessed.