Airway management in critically ill children and adults: systematic review of international guidelines.

ntroduction Airway management is a critical skill in intensive care, as tracheal intubation carries significant risks. Optimizing safety and first-pass success is essential in both adults and children. In resource-limited settings, equipment con- straints and training gaps further complicate this manage- ment, highlighting the need for standardized, evidence- based approaches. Objectives: This systematic review aimed to synthesize existing international guidelines on airway management in critically ill adults and children, identify differences between populations, challenges in resource-limited settings, and evidence-based strategies to optimize safety and first-pass success. Methods A systematic search was conducted in PubMed, Embase, the Cochrane Library, and national and international guideline databases up to January 2025. Guidelines pub- lished since 2010, concerning adult or pediatric popula- tions and including pharmacological and/or non-pharma- cological recommendations, were eligible. Two review- ers independently selected studies, extracted data, and assessed methodological quality using the AGREE II tool. Recommendations were compared according to population, type of intervention, and level of evidence, and results were synthesized qualitatively. Results Among 1,482 references, 42 guidelines were included: 18 for adults, 12 for children, and 12 for resource-limited settings. The main recommendations for adults included optimized preoxygenation, bougie-assisted intubation, and systematic preparation to reduce complications. Pe- diatric guidelines emphasized anatomical and physiolog- ical adaptations, the use of videolaryngoscopy, and trained teams. In resource-limited settings, priority was given to simplified bundles, standardized protocols, and targeted training. The certainty of evidence was high for adults, moderate for pediatric recommendations, and var- iable for resource-limited settings. Conclusion Despite universal principles, their implementation must take into account patient age, physiological differences, and resource availability. Standardized protocols, appro- priate use of airway management tools, and dedicated team training are essential to reduce complications and improve first-pass success. This review provides clini-cians and policymakers with practical guidelines for safe and effective airway management in various critical care settings.