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Open research questions in Airway Management and Intubation Techniques

50 unresolved questions extracted from the limitations and future-work sections of 578 Airway Management and Intubation Techniques papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Background/Objectives: In patients without clinically anticipated difficulty, an unexpected difficult airway carries the greatest potential for harm, yet routine bedside tests exclude difficulty poorly, and evidence for point-of-care ultrasonography remains heterogeneous, with difficult mask ventilation rarely studied as a distinct outcome.

    Tongue Thickness and Skin-to-Hyoid Distance as Ultrasonographic Markers of Difficult Airway in Patients Without Anticipated Difficulty: A Prospective Diagnostic Accuracy Study of 713 Adults · 2026 · DOI

  • Although causal inference is limited by the retrospective design and small event number, clinicians should maintain a high index of suspicion for AD in patients with these risk factors to facilitate early diagnosis and timely intervention.

    Association of nasogastric tube or transesophageal echocardiography probe use and head and neck positioning with arytenoid dislocation after endotracheal intubation: a retrospective cohort study · 2026 · DOI

  • When occult PITS converges with active status epilepticus and critical respiratory acidosis, the resulting triple jeopardy airway crisis represents the highest-risk clinical pattern in which standard CICO algorithms are insufficient without anatomical contextualisation.

    Silent Post-intubation Tracheal Stenosis Unmasked by Status Epilepticus in a Paediatric Neurotrauma Survivor: A Triple Jeopardy Airway Crisis · 2026 · DOI

  • The limitations of our study include the need for advanced training in ultrasound for reproducibility in clinical practice. A multi-centric study done by different expert sonologists will further open more results and research avenues that will give more robust evidence for clinical practice. Since the study population is from a university teaching hospitals that caters to different population subsets from across the country, it may not be applicable for ethnicities from other countries which can explain that Lin et al had a DMV with TT > 6.96 cm while we had DMV when TT > 4.67 cm (34). More importantly, there is paucity of literature on ultrasound predictors of DMV. Hence, we used conventional DMV parameters to find the predictability of difficulty in mask ventilation to associate with ultrasound airway parameters like DLA, TT, and LPWT. From our novel study, the DLA and TT statistically predicts DMV. So, they were used to predict DMV among various subgroups, and we found a statistically significance with STOP BANG >2, snoring and age > 55 (p<0.05). Further research in this area with subset populations, such as obesity, and higher STOP-BANG scores in a greater number of populations in different centres, difficulty in mask ventilation after neuromuscular blockade etc., will throw more light on the pre-operative utility of ultrasound parameters in predicting DMV. Since most difficult airway predictors are poorly sensitive when used as standalone predictors, we suggest the combined use of DLA and TT to predict DMV. Adding on to the classical clinical parameters for DMV, ultrasound parameters of DLA and TT will add to successful prediction of DMV.

    Ultrasound Guided Airway Parameters for Predicting Difficult Mask Ventilation: A Prospective Observational Study · 2026 · DOI

  • Future prospective trials are warranted to explore the potential complex relationships between supine CP, position-induced CP changes, and anesthesia duration and to assess the clinical need for continuously regulating LMA cuff pressure after head rotation during prolonged otologic surgeries to optimize postoperative recovery.

    Intraoperative supraglottic airway device, anesthetic, and mechanical factors associated with acute postoperative sore throat in elective tympanoplasty: a retrospective cohort study · 2026 · DOI

  • Lateral head rotation during surgery alters LMA intracuff pressure (CP), but the relationship between these pressure changes and POST remains unclear.

    Intraoperative supraglottic airway device, anesthetic, and mechanical factors associated with acute postoperative sore throat in elective tympanoplasty: a retrospective cohort study · 2026 · DOI

  • 1859787 We acknowledge that our oxygen utilization model is a simpli- fied estimation of gross delivery and does not account for the meta- bolic efficiency of semi-closed GA circuits. Fourth, oxygen delivery calculation is a simplified model for gross resource estima- tion and does not account for the efficiency of gas rebreathing or specific fresh gas flow settings in the GA group.

    Respiratory safety and resource utilization in ERCP: a comparative study of high-flow nasal oxygen, conventional mask, and general anesthesia in high-risk populations · 2026 · DOI

  • AI is expected to play an increasingly important role in airway management as computational capabilities, data availability, and algorithm performance continue to improve. Although current applications are primarily focused on difficult airway prediction and procedural support, future developments may transform multiple aspects of airway assessment, decision-making, training, and clinical practice. One of the most promising future applications is the development of multimodal predictive systems that integrate diverse sources of patient information. Current airway assessment methods often rely on individual clinical parameters or isolated imaging findings. Future AI platforms may combine demographic characteristics, facial photographs, voice recordings, ultrasound images, radiological data, electronic health records, and physiological measurements into a single predictive framework. Such comprehensive models could provide highly personalized risk assessments and improve the identification of patients at risk for difficult airway management. [19-21] Advances in computer vision and DL are also likely to enhance real-time airway guidance during videolaryngoscopy and tracheal intubation. Future AI-enabled videolaryngoscopes may automatically 2026 Ashraf et al. Cureus 18(6): e110566. DOI 10.7759/cureus.110566 7 of 12 identify airway structures, assess glottic visualization, verify endotracheal tube placement, and provide immediate procedural recommendations. Integration of augmented reality technology may allow anatomical landmarks and guidance prompts to be projected directly onto the operator’s display, potentially improving first-pass intubation success and reducing complications. [22-24] Ultrasound-based airway assessment represents another area of significant future potential. Automated image interpretation systems may simplify airway ultrasonography and reduce operator dependency. AI algorithms capable of real-time analysis of airway anatomy could facilitate rapid bedside assessment, particularly in emergency and critical care settings. As portable ultrasound devices become increasingly available, integration with AI may expand access to advanced airway evaluation tools. [26] AI may also contribute to the development of intelligent clinical decision-support systems. Such platforms could assist clinicians in selecting appropriate airway management strategies based on patient-specific characteristics and current clinical guidelines. During high-stress situations, AI systems may function as cognitive aids by providing reminders, risk alerts, and evidence-based recommendations. These tools have the potential to reduce human error and improve adherence to established airway management algorithms. The future may also witness the emergence of robotic and semi-autonomous airway management systems. Experimental studies have already demonstrated the feasibility of AI-guided robotic intubation under controlled conditions. Although widespread clinical implementation remains distant, advances in robotics, ML, and computer vision may eventually enable remote airway interventions and support airway management in resource-limited environments. In medical education, AI-powered simulation platforms are expected to become increasingly sophisticated. Adaptive learning systems capable of tailoring educational content to individual learner needs may improve training efficiency and competency development. Virtual reality and augmented reality technologies integrated with AI-driven feedback systems may provide highly realistic and personalized learning experiences for airway management trainees. Despite these exciting possibilities, future progress will depend on addressing several important challenges. Large multicentre studies are needed to validate existing models across diverse populations and clinical settings. The development of explainable AI frameworks will be essential to improve transparency and clinician trust. Regulatory oversight, ethical governance, and robust data security measures must evolve alongside technological advances to ensure safe and responsible implementation. Ultimately, the future of AI in airway management is unlikely to involve the replacement of clinicians. Instead, AI is expected to function as a powerful adjunct that complements human expertise by enhancing prediction, improving decision-making, supporting procedural performance, and facilitating education. The most effective airway management strategies will likely arise from collaboration between skilled clinicians and intelligent technological systems. Emerging applications and future directions of AI in airway management are summarized in Table 3.

    Artificial Intelligence in Airway Management: Current Evidence and Future Perspectives · 2026 · DOI

  • 8–14 Breaths/min 0–5 cm H2O 6–8 mL/kg ideal body weight <30 cm H2O Tolerate pH $ 7.20 Data from Manthous, Weingart, Mosier et al., and Leatherman (24,28,49,53). occurs, the patient should be disconnected from the ventilator and external pressure applied on the chest to allow for complete exhalation and restarting at a lower respiratory rate when mechanical ventilation resumes (49). The plateau pressure estimates end inspiratory alveolar pressure and reflects total respiratory system compliance; plateau pressure should be assessed with an end inspiratory hold and maintained at <30 cm H2O (28,49). A plateau pressure of >30 cm H20 in the setting of obstructive lung disease likely indicates hyperinflation from auto-PEEP (53). The peak pressure will be elevated because of airway resistance, but this pressure is less important, and can be tolerated, if the plateau pressure remains <30 cm H2O, because the peak pressure is not parenchyma alveoli of transmitted (24,28,53). An example of a pressure waveform in a mechanically ventilated patient with high airway resistance is shown in Figure 2. lung the to Pearl: Assess for air trapping on the ventilator. Air trapping from a high respiratory rate can lead to hemodynamic collapse; a patient with a high spontaneous respiratory rate may require deep sedation with or without neuromuscular blockade. The plateau pressure should be assessed and maintained at <30 cm H2O. Pulmonary Hypertension, RV Failure, and PE Pitfall: Failure to identify a patient with pulmonary hypertension or RV failure. Figure 2. High airway resistance on pressure waveform. High-Risk Airway Management in the ED 91 function and cardiac output hypercapnia, (12,57,58). Based on interventricular dependence, RV dilation and pressure overload may lead to bulging of the interventricular septum and compromise left ventric- (57–60). Acute ular hypoxemia, to pulmonary vasoconstriction, and these precipitants of an acute rise in PVR should be aggressively avoided in the failing RV (57,58,61). The patient must be preoxygenated, and during induction, hypercapnia and hypoxemia should be avoided (49). acidosis lead and Pearl: Avoid and manage precipitants of increased PVR, including hypoxia, hypercapnia, and acidosis. Pitfall: Not treating hypotension, leading to an underperfused and ischemic RV. The RV is perfused during systole and diastole because of the typically low RV pressure and low ventricular wall tension (58,59). When the pulmonary artery pressure exceeds systemic blood pressure, RV perfusion decreases, resulting in RV ischemia and a potentially deleterious cycle of refractory RV failure, low cardiac output, hypotension, and hemodynamic collapse (57,58). Preinduction systemic hypotension or hypotension during an intubation attempt, particularly in combination with an increase in PVR from hypoxemia or hypercapnia during an apneic period, may precipitate this deadly cycle (12,57).

    Letter to the Editor: Insight into emergency endotracheal intubation in critically ill and strategies beyond equipment · 2026 · DOI

  • While this study offers valuable insights, it is essential to rec- ognize its inherent limitations. The research was conducted in a simulated environment, which may not entirely mir- ror the complexities of real-world clinical scenarios. More- over, the study sample was limited to emergency medical res- idents and paramedics, potentially restricting the generaliz- ability of the findings to the broader spectrum of healthcare providers. Consequently, further investigations with larger, more diverse participant cohorts are warranted to corrobo- rate and extend these findings. Another limitation is the absence of data regarding the spe- cific angles of cervical spine movement and their potential associations with neurological outcomes. As a result, there exists a need for supplementary research in this domain to gain a more comprehensive understanding of the impact of cervical spine angles on patient outcomes.

    Letter to the Editor: Optimal device for emergency intubation - a commentary on the complementary role of intubating laryngeal mask airway-video laryngoscope · 2026 · DOI

  • The anesthetic management protocol used, including third-generation LMA, total intravenous anesthesia, quantitative neuromuscular monitoring, and PACU extubation, may differ from routine practice in some settings.

    Laryngeal mask airway versus endotracheal tube for preventing postoperative atelectasis after laparoscopic surgery: a randomized controlled trial · 2026 · DOI

  • Treating the ordinal LUS score as an approximately continuous variable for sample size estimation is a methodological approximation that may not fully capture the underlying ordinal nature of the outcome.

    Laryngeal mask airway versus endotracheal tube for preventing postoperative atelectasis after laparoscopic surgery: a randomized controlled trial · 2026 · DOI

  • Previous studies have reported the clinical utility of the LMA® Supreme™ (LMA Supreme) in laparoscopic surgery under general anesthesia, but there has been limited research on the effectiveness of the self-pressurized Air-Q® (Air-Q) in this clinical context.

    Comparison of the Air-Q®sp versus the LMA® Supreme™ in patients undergoing laparoscopic gynecologic surgery: a single-blind, randomized controlled trial · 2024 · DOI

  • CONCLUSION: While analysis of the CFD simulation was limited by the collected data available, a finding consistent with published literature was that the OSA subject group simulation models depicted the point of lowest pressure coinciding with the area of maximum constriction.

    Evaluation of upper airway characteristics in patients with and without sleep apnea using cone‐beam computed tomography and computational fluid dynamics · 2023 · DOI

  • The combined use of laryngoscopy with fiberoptic bronchoscope (CLBI) has been proposed in this regard, but its performance by novices facing DAM remain unexplored.

    Use of combined laryngo-bronchoscopy intubation approach in a simulated difficult airway scenario with cervical stabilization · 2023 · DOI

  • The combined use of laryngoscopy with fiberoptic bronchoscope (combined laryngo-bronchoscope intubation, CLBI) has been proposed but its performances in novices and the best timing for introduction during training remain not explored.

    Combined laryngo-bronchoscopy intubation approach in the normal airway scenario: a simulation study on anesthesiology residents · 2023 · DOI

  • Background: Upper airway analysis is an often-cited use of CBCT imaging by orthodontists; however, the reliability of airway measurements using this technology is not fully established.

    Reliability of upper airway assessment using CBCT · 2018 · DOI

  • The paper addresses prevention of the lethal triad (hypothermia, acidosis, coagulopathy) in hemorrhagic shock but does not provide specific temperature thresholds, acidosis correction targets, or sequential intervention protocols for remote health care facilities with only crystalloid resuscitation available.

    Retrieval Medicine · 2016 · DOI

  • Biphasic anaphylactic reactions are mentioned as a consideration during retrieval but the incidence, timing intervals, and risk stratification criteria for identifying high-risk patients requiring extended monitoring protocols during transfer to tertiary care are not specified.

    Retrieval Medicine · 2016 · DOI

  • The paper identifies C1-esterase deficiency as a consideration in anaphylactic shock cases unresponsive to standard therapy, but provides no guidance on diagnostic criteria, prevalence in anaphylaxis retrievals, or protocols for C1-esterase inhibitor concentrate administration timing during retrieval medicine operations.

    Retrieval Medicine · 2016 · DOI

  • While thromboelastogram-guided resuscitation is mentioned for hemorrhagic shock management, the specific transfusion ratios and repeated measurement protocols for thromboelastograms in massive transfusion scenarios at tertiary facilities have not been systematically evaluated or compared against standard coagulation monitoring.

    Retrieval Medicine · 2016 · DOI

  • The ProCESS trial demonstrated equivalence between central venous oxygen saturation monitoring and venous lactate-guided resuscitation in septic shock, but the optimal balance point between adequate fluid resuscitation to prevent renal failure and cautious resuscitation to prevent fluid overload in septic shock patients requiring inotrope support has not been quantitatively defined.

    Retrieval Medicine · 2016 · DOI

  • An ad hoc Working Group team identified five specific gap areas in the cricothyroidotomy training: (1) limited gross airway anatomy review; (2) lack of "hands-on" human laryngeal anatomy; (3) nonstandardized step-by-step surgical incision skill procedure; (4) inferior standards for anatomically correct cricothyroid mannequins; (5) lack of standardized refresher training frequency.

    Cricothyroidotomy Bottom–Up Training Review: Battlefield Lessons Learned · 2011 · DOI

  • METHODS: The online survey consisted of 34 multiple-choice questions and three open questions available for 13 months.

    Awake tracheal intubation in the era of videolaryngoscopy: an international survey of 4728 clinicians · 2026 · DOI

  • CONCLUSION: This project demonstrates value of collaborative working in the development of an animation and infographic; the basis of the idea being born out of identified gaps in the research.

    Co-designing laryngectomy accessible information to support the development of an education and training package for community healthcare professionals: experiences and reflections from multiple stakeholders · 2026 · DOI

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