Intensive Care Medicine,
Abstract
Purpose: Our study aimed to provide consensus and expert clinical practice statements related to airway manage‑
ment in critically ill adults with a physiologically difcult airway (PDA).
Methods: An international Steering Committee involving seven intensivists and one Delphi methodology expert
was convened by the Society of Critical Care Anaesthesiologists (SOCCA) Physiologically Difcult Airway Task Force.
The committee selected an international panel of 35 expert clinician–researchers with expertise in airway manage‑
ment in critically ill adults. A Delphi process based on an iterative approach was used to obtain the fnal consensus
statements.
Results: The 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 difcult 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 frst attempt, preoxygenation
