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Copyright (c) 2024 Faya Hadi Asseri, Hussein Ahmed Muri , Khalid ali abdullah , Abdulaziz hassan nahari, Naif Ahmed Alhazmi, Afaf Marzouq Raqea , Maria Ali Hakami , mohd ahmed mohd asiri, AHMED AWADH B ALRASHDI, Asma Rashed Lafi Aljohani, Amjad ayesh almomen, Sanaa Abdullah Dluim AlQhtine , EMAN MANSOOR AHMED ALJISHI
This work is licensed under a Creative Commons Attribution 4.0 International License.
Airway Management And Airway Clearance For Nursing And Respiratory Therapists And Paramedics
Corresponding Author(s) : Faya Hadi Asseri
Saudi Journal of Medicine and Public Health,
Vol. 1 No. 1 (2024)
Abstract
Background: Airway management and clearance are critical skills for healthcare professionals, including nurses, respiratory therapists, and paramedics, to ensure adequate oxygenation and ventilation in patients. These interventions are vital in diverse settings, from emergency departments to prehospital care, where delays or errors can lead to severe complications.
Aim: This review examines current practices, challenges, and evidence-based strategies in airway management and clearance across nursing, respiratory therapy, and paramedicine. It evaluates skill acquisition, interprofessional collaboration, and the effectiveness of various techniques in different clinical environments.
Methods: A systematic analysis of existing literature was conducted, focusing on airway assessment, basic and advanced techniques (e.g., endotracheal intubation, supraglottic devices), and airway clearance methods (e.g., chest physiotherapy, suctioning). Studies on training effectiveness, simulation-based learning, and interdisciplinary approaches were included.
Results: Findings indicate variability in competency levels among healthcare providers, with paramedics facing challenges in prehospital intubation (first-pass success rates as low as 56%). Nurses demonstrated gaps in airway emergency knowledge, while respiratory therapists excelled in evidence-based airway clearance. Interprofessional training improved outcomes, and supraglottic devices were preferred in prehospital settings for their ease of use.
Conclusion: Effective airway management requires standardized training, simulation-based practice, and interdisciplinary collaboration. Tailored interventions based on patient needs and care settings enhance outcomes. Future research should address training disparities and compare airway clearance techniques for optimal clinical application.
Background: Airway management and clearance are critical skills for healthcare professionals, including nurses, respiratory therapists, and paramedics, to ensure adequate oxygenation and ventilation in patients. These interventions are vital in diverse settings, from emergency departments to prehospital care, where delays or errors can lead to severe complications.
Aim: This review examines current practices, challenges, and evidence-based strategies in airway management and clearance across nursing, respiratory therapy, and paramedicine. It evaluates skill acquisition, interprofessional collaboration, and the effectiveness of various techniques in different clinical environments.
Methods: A systematic analysis of existing literature was conducted, focusing on airway assessment, basic and advanced techniques (e.g., endotracheal intubation, supraglottic devices), and airway clearance methods (e.g., chest physiotherapy, suctioning). Studies on training effectiveness, simulation-based learning, and interdisciplinary approaches were included.
Results: Findings indicate variability in competency levels among healthcare providers, with paramedics facing challenges in prehospital intubation (first-pass success rates as low as 56%). Nurses demonstrated gaps in airway emergency knowledge, while respiratory therapists excelled in evidence-based airway clearance. Interprofessional training improved outcomes, and supraglottic devices were preferred in prehospital settings for their ease of use.
Conclusion: Effective airway management requires standardized training, simulation-based practice, and interdisciplinary collaboration. Tailored interventions based on patient needs and care settings enhance outcomes. Future research should address training disparities and compare airway clearance techniques for optimal clinical application.
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- StatPearls Publishing. (2017, December 22). Airway management [StatPearls Online]. In StatPearls. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470403/
- Nigatu, M., Debebe, F., & Tuli, W. (2022). Assessment of knowledge, practice, and associated factors towards airway and breathing management among nurses working in the emergency departments of selected public hospitals in Addis Ababa, Ethiopia: A crosssectional study. Open Access Emergency Medicine, 14, 235–247.
- Higginson, R., Jones, B., & Davies, K. (2010). Airway management for nurses: Emergency assessment and care. British Journal of Nursing, 19(16), 1006–1014. https://doi.org/10.12968/bjon.2010.19.16.78185
- Bell, S., Pennington, B., Hill, J., & Harrison, J. (2022). Prehospital Airway Management. Journal of paramedic practice : the clinical monthly for emergency care professionals, 14(2), 51–53. https://doi.org/10.12968/jpar.2022.14.2.51
- Belli, S., Prince, I., Savio, G., Paracchini, E., Cattaneo, D., Bianchi, M., Masocco, F., Bellanti, M. T., & Balbi, B. (2021). Airway Clearance Techniques: The Right Choice for the Right Patient. Frontiers in medicine, 8, 544826. https://doi.org/10.3389/fmed.2021.544826
- Finn, J. C., Brink, D., Mckenzie, N., Garcia, A., Tohira, H., Perkins, G. D., ... & Bailey, P. (2022). Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: a randomised controlled trial. Emergency Medicine Journal, 39(1), 37-44.
- Deng, J., Huang, S., Zou, D., Liu, W., He, M., Xiong, J., & Wang, H. (2021). Investigation of the airway management practice of emergency department ward nurses: A nationwide survey in China. BMJ Open, 11(12), Article e049869. https://doi.org/10.1136/bmjopen2021e049869
- aber, M. E., Ali, A., & Abdelrahman, H. A. (2023). Critical care nurses’ practice of endotracheal tube suctioning in intensive care units: An observational study. Mansoura Nursing Journal, (MNJ). https://doi.org/10.21608/mnj.2023.322074
- Tola, D. H., Rojo, A., & Morgan, B. (2021). Basic airway management for the professional nurse. The Nursing Clinics of North America, 56(3), 379–388. https://doi.org/10.1016/j.cnur.2021.04.005
- Chowdhury, R., Orishchak, O., Mascarella, M. A., Aldriweesh, B., Alnoury, M. K., BousquetDion, G., Yeung, J., & Nguyen, L. H.N. P. (2025). Emergency airway management: A systematic review on the effectiveness of cognitive aids in improving outcomes and provider performance. Clinics and Practice, 15(1), Article 13. https://doi.org/10.3390/clinpract15010013
- Zahran, H., Malak, M. Z., ElQirem, F., & Asfour, B. (2024). The effect of virtual reality airway management as a learning strategy on performance, selfefficacy, and emotional intelligence among nursing students in the West Bank, Palestine. Teaching and Learning in Nursing. Advance online publication.
- Warnock, L., & Gates, A. (2023). Airway clearance techniques compared to no airway clearance techniques for cystic fibrosis (Cochrane Review, Issue 4, Art. No. CD001401). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001401.pub4
- Gursli, S., Quittner, A., Jahnsen, R. B., Skrede, B., Stuge, B., & Bakkeheim, E. (2022). Airway clearance physiotherapy and healthrelated quality of life in cystic fibrosis. PLoS ONE, 17(10), Article e0276310. https://doi.org/10.1371/journal.pone.0276310
- Voss, S., Rhys, M., Coates, D., Greenwood, R., Nolan, J. P., Thomas, M., & Benger, J. (2014). How do paramedics manage the airway during outofhospital cardiac arrest? Resuscitation, 85(12), 1662–1666. https://doi.org/10.1016/j.resuscitation.2014.09.008
- Panchal, A. R., Finnegan, G., Way, D. P., & Terndrup, T. (2016). Assessment of paramedic performance on difficult airway simulation. Prehospital Emergency Care, 20(3), 411–420. https://doi.org/10.3109/10903127.2015.1102993
- Shimizu, K., et al. (2021). Effect of advanced airway management by paramedics during outofhospital cardiac arrest on chest compression fraction and return of spontaneous circulation. Open Access Emergency Medicine, 13, 305–310. https://doi.org/10.2147/OAEM.S319385
- Deakin, C. D., King, P., & Thompson, F. (2009). Prehospital advanced airway management by ambulance technicians and paramedics: Is clinical practice sufficient to maintain skills? Emergency Medicine Journal, 26(12), 888–891. https://doi.org/10.1136/EMJ.2008.064642 public.nlm.nih.gov+5
- Cook, T. M., & Hommers, C. (2006). New airways for resuscitation?. Resuscitation, 69(3), 371-387.
References
StatPearls Publishing. (2017, December 22). Airway management [StatPearls Online]. In StatPearls. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470403/
Nigatu, M., Debebe, F., & Tuli, W. (2022). Assessment of knowledge, practice, and associated factors towards airway and breathing management among nurses working in the emergency departments of selected public hospitals in Addis Ababa, Ethiopia: A crosssectional study. Open Access Emergency Medicine, 14, 235–247.
Higginson, R., Jones, B., & Davies, K. (2010). Airway management for nurses: Emergency assessment and care. British Journal of Nursing, 19(16), 1006–1014. https://doi.org/10.12968/bjon.2010.19.16.78185
Bell, S., Pennington, B., Hill, J., & Harrison, J. (2022). Prehospital Airway Management. Journal of paramedic practice : the clinical monthly for emergency care professionals, 14(2), 51–53. https://doi.org/10.12968/jpar.2022.14.2.51
Belli, S., Prince, I., Savio, G., Paracchini, E., Cattaneo, D., Bianchi, M., Masocco, F., Bellanti, M. T., & Balbi, B. (2021). Airway Clearance Techniques: The Right Choice for the Right Patient. Frontiers in medicine, 8, 544826. https://doi.org/10.3389/fmed.2021.544826
Finn, J. C., Brink, D., Mckenzie, N., Garcia, A., Tohira, H., Perkins, G. D., ... & Bailey, P. (2022). Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: a randomised controlled trial. Emergency Medicine Journal, 39(1), 37-44.
Deng, J., Huang, S., Zou, D., Liu, W., He, M., Xiong, J., & Wang, H. (2021). Investigation of the airway management practice of emergency department ward nurses: A nationwide survey in China. BMJ Open, 11(12), Article e049869. https://doi.org/10.1136/bmjopen2021e049869
aber, M. E., Ali, A., & Abdelrahman, H. A. (2023). Critical care nurses’ practice of endotracheal tube suctioning in intensive care units: An observational study. Mansoura Nursing Journal, (MNJ). https://doi.org/10.21608/mnj.2023.322074
Tola, D. H., Rojo, A., & Morgan, B. (2021). Basic airway management for the professional nurse. The Nursing Clinics of North America, 56(3), 379–388. https://doi.org/10.1016/j.cnur.2021.04.005
Chowdhury, R., Orishchak, O., Mascarella, M. A., Aldriweesh, B., Alnoury, M. K., BousquetDion, G., Yeung, J., & Nguyen, L. H.N. P. (2025). Emergency airway management: A systematic review on the effectiveness of cognitive aids in improving outcomes and provider performance. Clinics and Practice, 15(1), Article 13. https://doi.org/10.3390/clinpract15010013
Zahran, H., Malak, M. Z., ElQirem, F., & Asfour, B. (2024). The effect of virtual reality airway management as a learning strategy on performance, selfefficacy, and emotional intelligence among nursing students in the West Bank, Palestine. Teaching and Learning in Nursing. Advance online publication.
Warnock, L., & Gates, A. (2023). Airway clearance techniques compared to no airway clearance techniques for cystic fibrosis (Cochrane Review, Issue 4, Art. No. CD001401). Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001401.pub4
Gursli, S., Quittner, A., Jahnsen, R. B., Skrede, B., Stuge, B., & Bakkeheim, E. (2022). Airway clearance physiotherapy and healthrelated quality of life in cystic fibrosis. PLoS ONE, 17(10), Article e0276310. https://doi.org/10.1371/journal.pone.0276310
Voss, S., Rhys, M., Coates, D., Greenwood, R., Nolan, J. P., Thomas, M., & Benger, J. (2014). How do paramedics manage the airway during outofhospital cardiac arrest? Resuscitation, 85(12), 1662–1666. https://doi.org/10.1016/j.resuscitation.2014.09.008
Panchal, A. R., Finnegan, G., Way, D. P., & Terndrup, T. (2016). Assessment of paramedic performance on difficult airway simulation. Prehospital Emergency Care, 20(3), 411–420. https://doi.org/10.3109/10903127.2015.1102993
Shimizu, K., et al. (2021). Effect of advanced airway management by paramedics during outofhospital cardiac arrest on chest compression fraction and return of spontaneous circulation. Open Access Emergency Medicine, 13, 305–310. https://doi.org/10.2147/OAEM.S319385
Deakin, C. D., King, P., & Thompson, F. (2009). Prehospital advanced airway management by ambulance technicians and paramedics: Is clinical practice sufficient to maintain skills? Emergency Medicine Journal, 26(12), 888–891. https://doi.org/10.1136/EMJ.2008.064642 public.nlm.nih.gov+5
Cook, T. M., & Hommers, C. (2006). New airways for resuscitation?. Resuscitation, 69(3), 371-387.