A practice survey of airway management in Australian and New Zealand intensive care units: A 6-year follow-up study

Abstract

Airway management in critically ill patients remains an essential component of intensive care medicine and is associated with significant patient risks. We conducted a 6-year follow-up survey among intensive care unit (ICU) medical staff in Australia and New Zealand (ANZ) from June to September 2024 which explored current ICU airway management practices and compared these with our previous survey in 2019. Among 211 respondents (26% response rate), 79.6% were male and 70.6% were intensivists. Video laryngoscopy (VL) availability increased significantly to 100% (P=0.005). VL was the first-line choice for 82% of respondents (adjusted odd ratio (aOR) = 7.41; 95% confidence interval (CI): 4.33 to 12.67) and there was an increase in intubation checklist usage (aOR = 3.32; 95%CI: 1.88 to 5.86). The use of ketamine for induction doubled (33.2% versus 15.3%; aOR = 2.96; 95%CI: 1.65 to 5.31), and rocuronium (89.6%) was the most used neuromuscular-blocking agent. Only 15.1% consistently used a bougie or stylet, and half used bag–mask ventilation post-induction and prior to intubation. Only 54% of respondents were familiar with any guidelines, and less than half of respondents (46.4%) reported having any formal airway management training in the past 3 years. A majority (81%) supports mandatory airway management continuing professional development (CPD) for fellows of the College of Intensive Care Medicine of ANZ (CICM). Despite improvements in airway management among ANZ ICU clinicians, notable gaps persist between current practices and recent trial evidence and guideline recommendations, supporting the need for airway management CPD for CICM fellows.