Anaesthesia
July 15, 2026 · via Europe PMC
Awake tracheal intubation in the era of videolaryngoscopy: an international survey of 4728 clinicians.
Cortese G, Steinberg I, Brazzi L, +5 more, Greif R.
AI summary — for doctors, generated from the abstract only
Awake tracheal intubation use is heterogeneous worldwide, and clinicians fear that videolaryngoscopy is eroding skills and confidence.
What was studied
International online survey of 4,728 clinicians in 102 countries about awake tracheal intubation practice and barriers.
Key findings
- 76.2% performed awake intubation independently, and 41.2% perceived reduced use since videolaryngoscopy.
- Only 48.1% were familiar with guidelines, and 77.6% felt indications should be reassessed.
- 83.0% preferred a flexible endoscope, yet 60.7% cited limited bronchoscopy skill as limiting confidence.
Clinical relevance
Skill decay in a core airway technique is a patient safety concern when the airway is predicted difficult.
Who should care
Limitations
Self-selected online survey with variable item response and no measure of patient outcomes.
Maintain flexible endoscope proficiency through simulation and regular practice, and review local indications for awake intubation.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
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.
DOI
10.1111/anae.70291
PMID
42458235
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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