title: Systematic review of the anaesthetic management of non-iatrogenic acute adult airway trauma.
abstract: BACKGROUND
  Non-iatrogenic trauma to the airway is rare and presents a significant challenge to the anaesthetist. Although guidelines for the management of the unanticipated difficult airway have been published, these do not make provision for the 'anticipated' difficult airway. This systematic review aims to inform best practice and suggest management options for different injury patterns.
  
  
  METHODS
  A literature search was conducted using Embase, Medline, and Google Scholar for papers after the year 2000 reporting on the acute airway management of adult patients who suffered airway trauma. Our protocol and search strategy are registered with and published by PROSPERO (http://www.crd.york.ac.uk/PROSPERO, ID: CRD42016032763).
  
  
  RESULTS
  A systematic literature search yielded 578 articles, of which a total of 148 full-text papers were reviewed. We present our results categorized by mechanism of injury: blunt, penetrating, blast, and burns.
  
  
  CONCLUSIONS
  The hallmark of airway management with trauma to the airway is the maintenance of spontaneous ventilation, intubation under direct vision to avoid the creation of a false passage, and the avoidance of both intermittent positive pressure ventilation and cricoid pressure (the latter for laryngotracheal trauma only) during a rapid sequence induction. Management depends on available resources and time to perform airway assessment, investigations, and intervention (patients will be classified into one of three categories: no time, some time, or adequate time). Human factors, particularly the development of a shared mental model amongst the trauma team, are vital to mitigate risk and improve patient safety.
authors: Anaesthetic Department, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Aintree, Liverpool L9 7AL, UK Defence Medical Services, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK Postgraduate School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool L69 3GE, UK simonjmercer@hotmail.com.
authors: S J
authors: SJ
authors: Mercer
authors: Anaesthetic Department, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Aintree, Liverpool L9 7AL, UK.
authors: C P
authors: CP
authors: Jones
authors: Anaesthetic Department, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Aintree, Liverpool L9 7AL, UK.
authors: M
authors: M
authors: Bridge
authors: Anaesthetic Department, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Aintree, Liverpool L9 7AL, UK.
authors: E
authors: E
authors: Clitheroe
authors: Anaesthetic Department, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Aintree, Liverpool L9 7AL, UK Honorary Research Fellow, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
authors: B
authors: B
authors: Morton
authors: Anaesthetic Department, Aintree University Hospital NHS Foundation Trust, Longmoor Lane, Aintree, Liverpool L9 7AL, UK.
authors: P
authors: P
authors: Groom
mesh_terms: D058109:Airway Management / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D002056:Burns / Q000601:surgery; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods; D007830:Larynx / Q000293:injuries / Q000601:surgery; D012137:Respiratory System / Q000293:injuries* / Q000601:surgery; D014132:Trachea / Q000293:injuries / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery
keywords: airway management; blast injuries; blunt injuries; burns; wounds, penetrating