Principles of Airway Management
Abstract
Airway management has evolved from a practice centred on devices and technical skills toward a multidimensional model integrating physiology, human factors and patient safety. The generation of algorithms issued by different scientific societies has provided structure and reduced practice variability, but it has also produced conceptual fragmentation: each guideline uses its own terminology, sequences and emphases, making it difficult to distinguish what is genuinely universal from what reflects the particular specialty, country or clinical setting in which it was developed. The purpose of this project is to identify, through a critical and comparative narrative review, the universal principles that underpin modern airway management in adult patients. To this end, it contrasts current international guidelines (ASA, DAS, PUMA, Canadian Airway Focus Group, Safe Airway Society and guidelines for the critically ill), multicentre registries and national audits (NAP4, NAP7, NEAR), and the literature on peri-intubation physiology and human factors. The search was conducted in PubMed/MEDLINE, Scopus and Web of Science/Embase through August 2026, complemented by hand-searching of reference lists and direct consultation of the official websites of the leading scientific societies. The work deliberately refrains from proposing algorithms, sequences or operational models of its own. The expected outcome is to demonstrate that, beyond their algorithmic differences, the international evidence converges on a small set of principles that transcend devices and techniques: oxygenation, haemodynamic stability, prevention of pulmonary aspiration, avoiding improvisation, calling for help, and first-pass success. This framework is expected to provide a shared language across anaesthesiology, emergency medicine and critical care, to simplify teaching and simulation-based training, and to serve as the conceptual foundation on which future research may develop and formally validate cognitive models that operationalise these principles in clinical practice.
