• Angela M Merchan-Galvis, Juan P Caicedo, Carmen J Valencia-Payán, and Jose A Calvache.
• From the Department of Social Medicine and Family Health, Cochrane Affiliated Centre, Universidad del Cauca, Popayán, Colombia (AMM-G, CJV-P), Institute of Biomedical Research IIB, Public Health and Clinical Epidemiology Service, Hospital de la Santa Creu i Sant Pau (AMM-G), Department of Anaesthesiology, Universidad del Cauca, Popayán, Colombia (JPC, JAC), Grupo de Entrenamiento en Vía Aérea Latinoamérica (EVALA), Capítulo de Vía Aérea Difícil de La Confederación Latinoamericana de Sociedades de Anestesia (CLASA), Sociedad Colombiana de Anestesia y Reanimación (SCARE), Colombia (JPC) and Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands (JAC).
• Eur J Anaesthesiol. 2020 Jun 1; 37 (6): 451-456.

BackgroundComplications arising from airway management represent an important cause of morbidity and mortality. Clinical practice guidelines (CPGs) are systematically created documents that summarise knowledge and assist the delivery of high-quality medical care by identifying evidence that supports best clinical care.ObjectiveUsing the Appraisal of Guidelines for Research & Evaluation II instrument, we aimed to evaluate the methodological rigour and transparency of unanticipated difficult airway management CPGs in adults.DesignUsing PUBMED without language restrictions, we identified eligible CPGs between 1 January 1996 and 30 June 2019. All versions of a CPG were included as independent guidelines to assess improvements over time or the methodological limitations of each version. CPGs-related obstetrics or paediatrics or the management extubation in cases of difficult airway were excluded.ResultsFourteen CPGs were included. Of the six domains suggested by the Appraisal of Guidelines for Research & Evaluation II instrument, 'applicability' had the lowest score (23%) and 'scope and objectives' had the highest score (88%). The remaining domains (stakeholder involvement, editorial independence, rigour of development and clarity of presentation) had scores ranging between 56 and 81%. Overall, the highest scored CPG was the Difficult Airway Society 2015.ConclusionFuture updates of CPGs for difficult airway management in adults and severely ill patients should consider more emphasis on the applicability of their recommendations to real clinical practice.

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