• Nicole M Acquisto, Jarrod M Mosier, Edward A Bittner, Asad E Patanwala, Karen G Hirsch, Pamela Hargwood, John M Oropello, Ryan P Bodkin, Christine M Groth, Kevin A Kaucher, Angela A Slampak-Cindric, Edward M Manno, Stephen A Mayer, PetersonLars-Kristofer NLNDepartments of Critical Care Medicine and Emergency Medicine, Cooper University Health Care, Camden, NJ., Jeremy Fulmer, Christopher Galton, Thomas P Bleck, Karin Chase, Alan C Heffner, Kyle J Gunnerson, Bryan Boling, and Michael J Murray.
• Department of Pharmacy and Emergency Medicine, University of Rochester Medical Center, Rochester, New York, NY.
• Crit. Care Med. 2023 Oct 1; 51 (10): 141114301411-1430.

RationaleControversies and practice variations exist related to the pharmacologic and nonpharmacologic management of the airway during rapid sequence intubation (RSI).ObjectivesTo develop evidence-based recommendations on pharmacologic and nonpharmacologic topics related to RSI.DesignA guideline panel of 20 Society of Critical Care Medicine members with experience with RSI and emergency airway management met virtually at least monthly from the panel's inception in 2018 through 2020 and face-to-face at the 2020 Critical Care Congress. The guideline panel included pharmacists, physicians, a nurse practitioner, and a respiratory therapist with experience in emergency medicine, critical care medicine, anesthesiology, and prehospital medicine; consultation with a methodologist and librarian was available. A formal conflict of interest policy was followed and enforced throughout the guidelines-development process.MethodsPanelists created Population, Intervention, Comparison, and Outcome (PICO) questions and voted to select the most clinically relevant questions for inclusion in the guideline. Each question was assigned to a pair of panelists, who refined the PICO wording and reviewed the best available evidence using predetermined search terms. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used throughout and recommendations of "strong" or "conditional" were made for each PICO question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and best practice statements, when the benefits of the intervention outweighed the risks, but direct evidence to support the intervention did not exist.ResultsFrom the original 35 proposed PICO questions, 10 were selected. The RSI guideline panel issued one recommendation (strong, low-quality evidence), seven suggestions (all conditional recommendations with moderate-, low-, or very low-quality evidence), and two best practice statements. The panel made two suggestions for a single PICO question and did not make any suggestions for one PICO question due to lack of evidence.ConclusionsUsing GRADE principles, the interdisciplinary panel found substantial agreement with respect to the evidence supporting recommendations for RSI. The panel also identified literature gaps that might be addressed by future research.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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