INTRODUCTION: Awake tracheal intubation is recommended for the anticipated difficult airway, but its application worldwide is poorly understood. We performed an international survey to understand more about the current global utilisation of awake tracheal intubation and barriers to its more widespread implementation. METHODS: The online survey consisted of 34 multiple-choice questions and three open questions available for 13 months. Each participant agreed to anonymised data collection and analysis before undertaking the survey. RESULTS: Data were collected from 102 countries with 4728 responses. In total, 3190/4184 (76.2%) respondents stated that they were performing awake tracheal intubation independently and 2512/3035 (82.8%) used awake tracheal intubation for a combination of predicted anatomical difficulty and physiological risk. A decrease in awake tracheal intubation use was perceived by 1733/4204 (41.2%) following the widespread implementation of videolaryngoscopy. There were 2867/3695 (77.6%) respondents who felt that indications for awake tracheal intubation should be reassessed, although only 1844/3831 (48.1%) reported being familiar with awake tracheal intubation guidelines. Most used a combination of topical airway anaesthesia and systemic medications to facilitate awake tracheal intubation. There were 2521/3039 (83.0%) respondents who preferred to use a flexible endoscope, although a lack of skill in using flexible bronchoscopy was reported by 586/966 (60.7%) as limiting their confidence in awake tracheal intubation. DISCUSSION: Despite guidelines recommending use of awake tracheal intubation for the predicted difficult airway, its application is heterogeneous. Our data suggest that a lack of physician exposure to awake tracheal intubation, possibly associated with expanding use of videolaryngoscopy, may adversely impact clinician confidence in performing the procedure. Most respondents consider awake tracheal intubation to be a core skill for anaesthetists and, furthermore, videolaryngoscopy can be used to perform some awake tracheal intubations.
Cortese et al. (Wed,) studied this question.