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Airway Management: From Basic Techniques to Innovative Technologies
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Airway Management: From Basic Techniques to Innovative Technologies

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: 25 March 2026 | Viewed by 5775

Special Issue Editors

Dr. Kunal Karamchandani

E-Mail Website
Guest Editor
Division of Critical Care Medicine, Department of Anaesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
Interests: physiologically difficult airway; airway management; critical illness; patient outcomes; perioperative care; substance use disorders
Prof. Dr. Sheila Nainan Myatra

E-Mail Website
Guest Editor
Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Interests: physiologically difficult airway; airway management; critical illness; hemodynamic monitoring; sepsis and end of life care

Special Issue Information

Dear Colleagues,

Airway management for surgical procedures under general anesthesia as well as in critically ill patients has significant challenges and may be associated with poor patient outcomes. Clinicians involved with airway management have to take into account anatomic, physiological, and/ or logistical challenges during this process. While traditional approaches to airway management have stood the test of times, the advent of new techniques, devices, and technologies in this field is likely to impact patient outcomes in a positive way. Innovations in patient and airway operator optimization, performance of the procedure, and post tracheal intubation care are essential to advancing the field of airway management. The aim of this Special Issue is to provide a comprehensive overview of some of the time-tested basic techniques of airway management, while also discussing some of the newer advances in this field, along with future opportunities for innovation. Therefore, clinicians involved with airway management are encouraged to submit their original research and review articles to this Special Issue.

Dr. Kunal Karamchandani
Prof. Dr. Sheila Nainan Myatra
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • airway management
  • physiologically difficult airway
  • videolaryngoscopy
  • esophageal intubation
  • artificial intelligence

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Published Papers (4 papers)

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Research

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13 pages, 1079 KB  
Article
Ultrasound-Measured Skin-to-Epiglottis Distance as a Predictor of Difficult Intubation in Obese Patients: A Prospective Observational Study
by Kazım Ersin Altınsoy and Bahar Uslu Bayhan
J. Clin. Med. 2025, 14(6), 2092; https://doi.org/10.3390/jcm14062092 - 19 Mar 2025
Cited by 3 | Viewed by 1540
Abstract
Background/Objectives: Difficult intubation is a significant clinical issue in emergency medicine as well as anesthesia practice, occurring more frequently in obese patients. Traditional assessment methods may not be sufficient to predict difficult intubation. This study aims to evaluate the ability of ultrasound-measured [...] Read more.
Background/Objectives: Difficult intubation is a significant clinical issue in emergency medicine as well as anesthesia practice, occurring more frequently in obese patients. Traditional assessment methods may not be sufficient to predict difficult intubation. This study aims to evaluate the ability of ultrasound-measured skin-to-epiglottis distance (SED) to predict difficult laryngoscopy in obese patients and investigate its applicability in clinical practice. Methods: This prospective observational study was conducted between February 2024 and January 2025 at Gaziantep City Hospital on obese patients undergoing bariatric surgery. Patients aged 18 years and older with an American Society of Anesthesiologists (ASA) classification of I-II-III were included in the study. Demographic data, standard airway assessment parameters (neck circumference, thyromental distance, sternomental distance, etc.), and ultrasound-measured skin-to-epiglottis distance were recorded. All intubation procedures were performed by a single experienced anesthesiologist following standard protocols, and laryngoscope view was assessed according to the Cormack–Lehane classification. Results: Among the 61 patients included in the study, 16.4% were classified as having a difficult airway, and 13.1% experienced difficult intubation. No significant correlation was found between standard airway assessment parameters and difficult intubation. However, ultrasound-measured skin-to-epiglottis distance (SED) was significantly higher in patients with difficult intubation (p = 0.004), making it a strong predictor. Additionally, modified Mallampati (p < 0.001), modified Cormack–Lehane (p = 0.003), and Wilson scores (p = 0.001) were significant in predicting difficult airway, although Wilson score was not significant for difficult intubation (p = 0.099). Conclusions: Our study suggests that ultrasound-measured skin-to-epiglottis distance may be a valuable predictor of difficult intubation in obese patients. Given the limitations of preoperative assessment methods, incorporating ultrasound into airway evaluation as a complementary tool provides significant benefits. Larger-scale studies in the future are necessary to further assess the clinical efficacy of this method. Full article
(This article belongs to the Special Issue Airway Management: From Basic Techniques to Innovative Technologies)
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Review

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13 pages, 1022 KB  
Review
Preoxygenation in the ICU
by Clément Monet, Mathieu Capdevila, Inès Lakbar, Yassir Aarab, Joris Pensier, Audrey De Jong and Samir Jaber
J. Clin. Med. 2025, 14(20), 7305; https://doi.org/10.3390/jcm14207305 - 16 Oct 2025
Viewed by 1401
Abstract
Tracheal intubation is a frequent and high-risk procedure in the intensive care unit (ICU). Unlike elective intubation in the operating room, ICU intubation is often performed under emergent conditions in physiologically unstable patients, leading to increased technical difficulty and higher complication rates. Among [...] Read more.
Tracheal intubation is a frequent and high-risk procedure in the intensive care unit (ICU). Unlike elective intubation in the operating room, ICU intubation is often performed under emergent conditions in physiologically unstable patients, leading to increased technical difficulty and higher complication rates. Among these, hypoxemia is particularly frequent and represents a major determinant of morbidity and mortality. Optimizing preoxygenation is therefore a cornerstone of safe airway management in critically ill patients. The aim of this review is to explore the advantages and limitations of each preoxygenation strategy and to provide clinicians with clear, practical guidance to optimize airway management in the ICU. Preoxygenation aims to increase oxygen reserves in order to prolong the duration of safe apnea. Conventional methods include high-flow oxygen delivery through a tightly fitted face mask, though efficacy depends on minimizing leaks. More advanced strategies include non-invasive ventilation (NIV), which improves both alveolar oxygen fraction and lung volume, and high-flow nasal cannula (HFNC), which additionally allows apneic oxygenation during intubation. Randomized controlled trials, including the recent PREOXY study, demonstrate the superiority of NIV over facemask preoxygenation in reducing peri-intubation desaturation, particularly in hypoxemic patients. HFNC is valuable when NIV is contraindicated, while combined approaches (NIV plus HFNC) may further enhance efficacy. Beyond technique, structured protocols and team organization are crucial to reduce complications. In conclusion, preoxygenation is an essential, patient-specific intervention that mitigates the risks of ICU intubation. Familiarity with available methods enables clinicians to tailor strategies, optimize oxygenation, and improve patient safety during this high-risk procedure. Full article
(This article belongs to the Special Issue Airway Management: From Basic Techniques to Innovative Technologies)
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10 pages, 1342 KB  
Review
Review of Neurostimulation Therapies for Obstructive Sleep Apnea: Hypoglossal Nerve Stimulation and Beyond
by Patrícia dos Santos Cé, Maria Eduarda Schiestl Melo, Alan Alves Machado, Sarah Eden Ridge and Thomaz Fleury Curado
J. Clin. Med. 2025, 14(15), 5494; https://doi.org/10.3390/jcm14155494 - 4 Aug 2025
Viewed by 2156
Abstract
Obstructive sleep apnea (OSA) is a sleep-related respiratory disorder characterized by partial or complete obstruction of the upper airway, typically resulting in a decrease in arterial oxygen saturation and repeated awakenings from sleep. It is the most common sleep-related respiratory disorder, affecting 9% [...] Read more.
Obstructive sleep apnea (OSA) is a sleep-related respiratory disorder characterized by partial or complete obstruction of the upper airway, typically resulting in a decrease in arterial oxygen saturation and repeated awakenings from sleep. It is the most common sleep-related respiratory disorder, affecting 9% to 38% of adults. OSA is associated with loss of tone, improper contraction of the tongue, and pharyngeal dilator muscles of the upper airway during sleep. The gold-standard treatment for moderate-to-severe OSA is continuous positive airway pressure (CPAP). However, many patients have poor long-term compliance with CPAP. Stimulation of the upper airway with electrical activation of the hypoglossal nerve has emerged as a promising treatment for patients with moderate-to-severe OSA who have failed CPAP therapy. Objectives: The present paper aims to review the literature regarding neurostimulation for the treatment of OSA. Conclusions: Hypoglossal nerve stimulation (HNS) has shown favorable success and low morbidity in the management of moderate-to-severe OSA. Full article
(This article belongs to the Special Issue Airway Management: From Basic Techniques to Innovative Technologies)
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Other

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17 pages, 1427 KB  
Systematic Review
Suction-Assisted Laryngoscopy and Airway Decontamination (SALAD) for Emergency Airway Management: A Systematic Review of Evidence and Implementation
by Saniyah Shaikh, Hamad Hejazi, Safwaan Shaikh, Adeeba Sajid, Rida Shahab, Ayesha Deed, Rida Afnan, Anam Hashmi, Raiyan Ehtesham Ahmed Sharieff, Asfiya Naureen and Marcelo A. F. Ribeiro, Jr.
J. Clin. Med. 2025, 14(20), 7430; https://doi.org/10.3390/jcm14207430 - 21 Oct 2025
Viewed by 255
Abstract
Background: Emergency airway management is a crucial and complex procedure frequently performed in the emergency department (ED). Airway contamination usually caused by blood, secretions, and emesis impairs ventilation, reduces successful intubation, and increases the complication rates, leading to difficult laryngoscopy, delayed intubation, [...] Read more.
Background: Emergency airway management is a crucial and complex procedure frequently performed in the emergency department (ED). Airway contamination usually caused by blood, secretions, and emesis impairs ventilation, reduces successful intubation, and increases the complication rates, leading to difficult laryngoscopy, delayed intubation, and increased mortality rates. One technique employed to decontaminate these airways when standard approaches fail is Suction-Assisted Laryngoscopy and Airway Decontamination (SALAD). Methods: A comprehensive literature search was conducted across PubMed, Cochrane, and Science direct databases following a specific search strategy. All search results were screened in a two-stage process (title–abstract and full-text screening) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Data from finalized articles were extracted using a standardized excel file developed a priori. Lastly, quality and risk of bias were assessed using appropriate tools according to respective study designs, and data were narratively synthesized. Results: A total of 224 records were identified. Upon screening, seven studies were included consisting of five simulation-based studies and two clinical case reports. Simulation studies reported that SALAD training significantly improved first-pass intubation success (53.7–90.2%), reduced time to intubation (up to 30 s), and enhanced airway visualization. Clinical cases further reported successful first-pass intubation in patients with massive airway contamination without complications. Overall, across both study types, the SALAD technique improved airway management performance, provider confidence, and airway contamination control compared to standard suction techniques. Conclusions: This systematic review highlights the benefits of the SALAD technique by enhancing airway visualization, reinforcing it as a significant tool for contaminated airway management. Trainees who underwent SALAD training demonstrated improved first-pass intubation success, reduced intubation time, and increased operator confidence. While data from the included studies seems promising, most studies are small simulation-based studies with limited clinical outcome data. Given its clinical relevance and educational value, future studies must prioritize high-quality research in clinical environments to establish SALAD’s efficacy and to define its role in integration into prehospital protocols. Full article
(This article belongs to the Special Issue Airway Management: From Basic Techniques to Innovative Technologies)
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