Guidelines 2024: Emergency intubation of an adult outside the operating room and intensive care unit

To provide guidelines for guidelines on adult patient intubation in emergency settings outside the operating room and intensive care unit.

A consensus committee of 24 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et de Réanimation, SFAR) and the French Society of Emergency Medicine (Société Française de Médecine d'Urgence, SFMU) was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guideline developpement process was conducted independently of any industrial funding (e.g., pharmaceutical or medical device companies). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised.

The aim of these expert panel guidelines is to evaluate adult patient intubation in emergency settings outside the operating room and intensive care unit. The experts studied questions within 5 domains. Each question was formulated according to the PICO (Population, Intervention, Comparison, Outcome) model, and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analysed according to the GRADE® methodology.

The experts' synthesis and the application of the GRADE® method yielded 32 recommendations for adult patient intubation in emergency settings outside the operating room and intensive care unit. Among the formalised recommendations, 5 have high levels of evidence (GRADE 1), and 12 have low levels of evidence (GRADE 2). For 15 recommendations, the GRADE method could not be applied, resulting in expert opinions. 4 questions did not find any response in the literature. After 4 rounds of scoring and amendment, strong agreement was reached for all the recommendations.

There was strong agreement among experts for 36 recommendations to improve practices for adult patient intubation in emergency settings outside the operating room and intensive care unit.

Published by Anaesthesia, critical care & pain medicine, 2026. The guideline itself is at the source linked here.

doi.org/10.1016/j.accpm.2026.101744