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Project for Universal Management of Airways

@universalairway.org
69 followers 3 following 8 posts

PUMA is a global collaboration to produce universal guidelines for airway management that can be applied independent of geography, discipline or context.

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Project for Universal Management of Airways @universalairway.org · 29/08/2026
Technique for cricoid pressure From PUMA Guidelines for providing a foundation for airway management Full free text forever in @anaesjournal.bsky.social at associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
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Project for Universal Management of Airways @universalairway.org · 29/08/2026
Technique for hyperangulated videolaryngoscopy. From PUMA Guidelines for providing a foundation for airway management 2nd page of graphic on next post Full free text of guideline in @anaesjournal.bsky.social at associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
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Project for Universal Management of Airways @universalairway.org · 29/08/2026
Technique for neck rescue From the PUMA Foundation Guidelines Download high res images & more detailed description of tech at universalairway.org/downloads Full free text forever in @anaesjournal.bsky.social at associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
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Project for Universal Management of Airways @universalairway.org · 29/08/2026
Universal guidelines for providing a foundation for airway management now available for download. Free full text forever in @anaesjournal.bsky.social 🔑🔓♾ associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
associationofanaesthetists-publications.onlinelibrary.wiley.com
Project for Universal Management of Airways: guidelines for providing a foundation for airway management
Introduction Before commencing airway management in any individual patient, a foundation should be provided that establishes the capability of organisations, departments and practitioners to underta...
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Project for Universal Management of Airways @universalairway.org · 22/03/2025
Standardising capnograph & other monitoring also recommended by PUMA. associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/... 3 important points re capnograph specified in SALG recommendations. www.salg.ac.uk/salg-publica...
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Nicholas Chrimes @chrimesy.com · 01/09/2025
International Consensus Guidelines for Preventing Unrecognised Oesophageal Intubation. Free full text in @anaesjournal.bsky.social Supported by @dasairway.bsky.social @safeairwaysociety.org @asahq.bsky.social @rcoanews.bsky.social & many more… www.universalairway.org/puoi/support
associationofanaesthetists-publications.onlinelibrary.wiley.com
Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*
Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ...
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Safe Airway Society @safeairwaysociety.org · 14/08/2025
The Safe Airway Liaison Group in the UK have released a statement on displaying the waveform capnography trace in line with the @universalairway.org recommendations. The CO2 trace should be: 1. The bottom trace 2. White 3. Shaded in www.salg.ac.uk/salg-publica...
salg.ac.uk
SALG | SALG Statement on Waveform Capnography
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Safe Airway Society @safeairwaysociety.org · 14/08/2025
The @universalairway.org guidelines for preventing unrecognised oesophageal intubation are supported by @safeairwaysociety.org, @anzca.bsky.social & @dasairway.bsky.social VL should be used routinely whenever feasible. Clinical signs should not be used to exclude oesophageal intubation.
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Royal College of Anaesthetists @rcoanews.bsky.social · 14/08/2025
🚨We have retired "no trace, wrong place" to align with PUMA guidelines. Instead, with @assocanaes.bsky.social and @dasairway.bsky.social, our message is that if sustained exhaled CO2 is not detected, then oesophageal intubation must be ruled out. See our dedicated webpage👉 ow.ly/vOZs50WA03r
Image of a medical professional positioning an oxygen mask on a patient lying down. Text reads: If sustained exhaled C02 is not detected, then oesophageal intubation must be excluded.
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Nicholas Chrimes @chrimesy.com · 27/07/2025
3-step guide to mastering #HAVL from @cliffreid.bsky.social 1. Watch the video m.youtube.com/watch?v=aYo7... 2. Read the stepwise guide drive.google.com/file/d/14r_W... 3. Deliberate team practice (rinse & repeat)
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Safe Airway Society @safeairwaysociety.org · 27/07/2025
International consensus guidelines for preventing unrecognised oesophageal intubation from @universalairway.org
associationofanaesthetists-publications.onlinelibrary.wiley.com
Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*
Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ...
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Chris Nickson @precordialthump.bsky.social · 17/07/2025
Airway assistant (ala airway ally) litfl.com/airway-assis... the forgotten role in airway management in ED, ICU, and the wards… but an important one! #foamed #foamcc
litfl.com
Airway Assistant
Description of the airway assistant role in the ANZ critical care setting: responsibilities, tips, pitfalls for newcomers to the role
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Chris Nickson @precordialthump.bsky.social · 17/07/2025
Unrecognised esophageal intubation litfl.com/unrecognised... Largely derived from the superb PUMA guidelines by @chrimesy.com et al #foamed #foamcc
litfl.com
Unrecognised oesophageal intubation
Unrecognised oesophageal intubation: frequency, causes, prevention, recognition, actions, and confounders. Derived from PUMA guidelines.
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Nicholas Chrimes @chrimesy.com · 19/06/2025
Key points: 1. ALWAYS confirm criteria for sustained exhaled CO2 are satisfied. 2. NEVER use clinical signs to exclude oesophageal intubation 3. The fastest, simplest & most definitive way to exclude oesophageal intubation is to remove the tube AND ventilate with an alternate device.
Algorithm to be used if criteria for ‘sustained exhaled carbon dioxide’ aren’t met. Features criteria for sustained exhaled CO2’, instructions not to use clinical signs to exclude oesophageal intubation & prompt to not only remove tube but also ventilate with a facemask or supraglottic airway as the default action if oesophageal intubation cannot be excluded.
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Project for Universal Management of Airways @universalairway.org · 19/06/2025
Organisations supporting the 'Consensus guidelines for preventing unrecognised oesophageal intubation' incl both @anzca.bsky.social and @rcoanews.bsky.social. Guidelines free full text in @anaesjournal.bsky.social: associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
associationofanaesthetists-publications.onlinelibrary.wiley.com
Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*
Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ....
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Nicholas Chrimes @chrimesy.com · 04/06/2025
But do patients at risk of aspiration need “a tube stuck in quickly”? It’s unlikely there’s actually a proportional incr in asp risk the longer the airway is unprotected. I’d suggest that regurg/asp mainly occurs w change in m tone at induction or w instrumentation while inadeq anaesthetised/relaxed
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Nicholas Chrimes @chrimesy.com · 04/06/2025
Aren’t there already things we would do when extubating a patient at incr risk of aspiration? Rather than being ‘rapid’ they relate to ensuring return of airway reflexes prior to removing tube (awake), potentially decreasing risk of regurg (gastric suction) & aspiration (lat position).
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Nicholas Chrimes @chrimesy.com · 04/06/2025
But what are the elements of intubation technique you’d encourage to reduce aspiration risk & do any of them relate to the components of RSI? I’d suggest that it’s more important that a patient is deeply anaesthetised/paralysed before the airway is instrumented than anything relating to rapidity.
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Nicholas Chrimes @chrimesy.com · 04/06/2025
Background reading for this week’s debate - this excellent editorial by @sthjournalclub.bsky.social & Craig Lyons in @anaesjournal.bsky.social associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/epdf/10....
associationofanaesthetists-publications.onlinelibrary.wiley.com
Rapid sequence induction: a modern‐day example of Theseus' Paradox?
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Anaesthesia @anaesjournal.bsky.social · 03/06/2025
Should we use universal videolaryngoscopy in real-world operating theatre settings? YES! ↑ rate of easy intubation ↑ rate successful first-attempt intubation ↓ incidence of difficult laryngoscopy ↓ complications related to intubation #AnSky #AirwaySky #MedSky doi.org/10.1111/anae...
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Anaesthesia @anaesjournal.bsky.social · 03/06/2025
In adult patients undergoing tracheal intubation in real-world operating theatre settings, universal VL showed clear advantages over direct laryngoscopy. This is the largest comparative analysis conducted to date! #AnSky #AirwaySky #MedSky doi.org/10.1111/anae...
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Nicholas Chrimes @chrimesy.com · 29/05/2025
Brilliant, provocative editorial from @sthjournalclub.bsky.social & Craig Lyons. While cricoid has been vilified out of existence in some areas by the EBM zealots, there's no evidence for benefit of any other aspect of RSI. Conversely CV compromise & use of rapid-onset NMBAs may cause harm.
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Nicholas Chrimes @chrimesy.com · 01/06/2025
Important paper on Airway Leads and implementing comprehensive airway quality improvement process in the Emergency Department from @emcrit.bsky.social Whether or not you agree w the specific interventions, this should be the template for all airway management programs.
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Cheery Littlebottom @cherrylittlebottom.bsky.social · 19/04/2025
Thio sux is the only classic (but I've never seen it done one, hence all being mRSI). I think otherwise it ought to be fast acting hypnotic and 1/kg or more of sux or roc. Opioids seem reasonable but I'd be worried about that being your sole "relaxant" I love www.universalairway.org/rsi above
universalairway.org
RSI — Project for Universal Management of Airways
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Nicholas Chrimes @chrimesy.com · 19/04/2025
For exactly this reason the @universalairway.org guidelines have removed the term “modified RSI” in favour of a defined spectrum of variations that constitute RSI. Anything outside this is not RSI. www.universalairway.org/rsi
universalairway.org
RSI — Project for Universal Management of Airways
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Nicholas Chrimes @chrimesy.com · 13/04/2025
It’s extraordinary that this is a case report in 2025. It’s like publishing a case of a CVC wire being lost intravascularly in which the authors conclude that it might be a good idea to always hold onto the wire.
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Nicholas Chrimes @chrimesy.com · 13/04/2025
“At least seven respondents reported in the free text comments that UOI could not happen to a competent anaesthetist and that further training was therefore not warranted” In my experience, the greatest barrier to uptake of the PUOI guidelines is getting clinicians to recognise they need them.
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Nicholas Chrimes @chrimesy.com · 11/04/2025
But I'm sure you'd agree that's clearly outdated & something the majority of clinicians would disagree with. In the @universalairway.org guidelines we've defined RSI based on a spectrum of practice that adheres to specific principles. www.universalairway.org/rsi
universalairway.org
RSI — Project for Universal Management of Airways
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Nicholas Chrimes @chrimesy.com · 11/04/2025
The term "TIVA RSI" misrepresents the issue. All RSIs are IV. Whether it's a TIVA anaesthetic depends on whether the subseq maintenance agent is inhaled or IV (& irrelevant to the process of RSI). The question is whether IV induction agents should be administered by an infusion pump during RSI.
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Cliff Reid @cliffreid.bsky.social · 28/03/2025
I underwent explainaesthesia this week and emerged knowing a LOT more about hyperangulated videolaryngoscopy thanks to @chrimesy.com youtu.be/aYo7kqu9QpA
youtu.be
INCREDIBLE Deep Dive into Hyperangulated Videolaryngoscopy
YouTube video by Cliff Reid
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Sarah Thornton @drmumsjt.bsky.social · 28/03/2025
Tim Cook heads up the charge to change from no trace=wrong place to sustained exhaled carbon dioxide as per Puma Guidelines @rcoanews.bsky.social #airwayleads
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RUH Anaesthetic Dept @ruhanaesthesia.bsky.social · 29/03/2025
Some anaesthetists now documenting ET Co2 x 7 on our anaesthetic charts to demonstrate following of guidelines
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Dr Gavin Sullivan A.N.A.E.S.T.H.E.T.I.S.T 🇳🇿🇦🇺🇬🇧 @lotusgav.bsky.social · 03/04/2025
@chrimesy.com @safeairwaysociety.org is the source of my teaching today. Great video on HAVL youtu.be/biHmn-q9HSw?... #ansky
youtu.be
Airwaves Episode 3 - Hyperangulated Videolaryngoscopy Virtual Workshop
YouTube video by Safe Airway Society
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doctimcook.bsky.social @doctimcook.bsky.social · 05/01/2025
The PUMA guidelines for prevention of oesophageal intubation are supported by -RCOA -AoA -FICM -ICS -CODP -DAS This is true of no other airway guidance I am aware of & make them the de facto UK National guidance associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/...
associationofanaesthetists-publications.onlinelibrary.wiley.com
Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*
Across multiple disciplines undertaking airway management globally, preventable episodes of unrecognised oesophageal intubation result in profound hypoxaemia, brain injury and death. These events occ....
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Anthony Lewis @antlewis.bsky.social · 03/04/2025
Seven breaths prevent death. A few months ago I did a grade 1, POGO 100% intubation with a VL. But on ventilation it didn’t feel right. Inflated the cuff a bit more. Still not right. Looked at ETCO2 trace, not right - low peaks. Tube out, reintubated. All good. 7 breaths prevent death.
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Difficult Airway Society (DAS) Residents @dasresidents.bsky.social · 28/03/2025
Time to retire ‘no trace, wrong place’ @doctimcook.bsky.social Many UOI do have ‘a trace’ It is all about sustained exhaled carbon dioxide @universalairway.org
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Project for Universal Management of Airways @universalairway.org · 22/03/2025
Standardising capnograph & other monitoring also recommended by PUMA. associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/... 3 important points re capnograph specified in SALG recommendations. www.salg.ac.uk/salg-publica...
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Nicholas Chrimes @chrimesy.com · 09/02/2025
Earlybird registration now open for #SAS2025Noosa the Safe Airway Society’s annual meeting Fri 12th Sep: PM workshops (optional) Sat 13th Sep: Full day interactive plenaries More info & registration: www.safeairwaysociety.org/eventdetails...
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