Curriculum for Airway Skills in Critically Ill Adults: a Delphi Evaluation

Airway management in critically ill patients is associated with significant morbidity and mortality. In an international Delphi study, the need for a training curriculum for airway management in critically Ill patients was identified. While attempts have been made to collaborate and define the training requirements in this field, further clarity is needed. In order to define the essential components of the training curriculum for airway management in critically ill patients, we plan to conduct an Delphi study involving a diverse group of international experts from various specialities, involved with airway management in critically ill patients.

The Delphi process is a well-established methodology to generate consensus on a particular topic using the "collective intelligence" of panel members.5,6 The steering committee members performed a literature search on the available evidence, including existing curriculum for airway management, drafted the initial statements, and will conduct iterative Delphi rounds to generate consensus among the experts. The Steering Committee members will not participate in the Delphi surveys themselves. The study findings will be reported according to the ACCORD criteria.

Steps of the Delphi process Step 1: Establishing a preliminary list of broad domains A focused literature review will be performed by the members of the SC and based on their input, the steering committee will identify broad domains, which will be used to draft statements for Round one of the Delphi process.

Step 2: Preparation of the Delphi Round One Survey The list of questions related to the above-mentioned domains will be sent to the Experts as a Delphi questionnaire. The anonymity of the Experts will be maintained until the end of the Delphi rounds. The Experts would be requested to answer questions related to training curriculum based on their experience and knowledge of the subject. The questions will be multiple choice or in the form of a 7-point Likert scale (strongly agree, agree, somewhat agree, neither agree nor disagree, somewhat disagree, disagree, strongly disagree). The experts can also provide their opinion on addition, deletion on questions or choices through free-text. The responses of experts will be collated during the analysis of results and shared in the following survey as controlled feedback.

Step 3: Subsequent Delphi Rounds The steering committee will review the results of round one. The statements listed will be modified, deleted, or added if found ambiguous based on the feedback and comments of the results. The remaining statements will be continued in the subsequent rounds until the stability of the responses is achieved. The cumulative results of round two will be presented to experts along with anonymized comments, and the survey process will be repeated with the modified questionnaire. The Delphi rounds will be continued until the desired consensus and stability is achieved for statements. .

Step 4: Final Consensus Only the statements that achieved consensus and stability will be used develop consensus statements. The results of the last stable round will be used to issue the consensus statements related to the above-mentioned domains. The results of the final survey, consensus statements, and the manuscript will be circulated among the experts for approval before submission for publication.

Statistical analysis

A descriptive analysis of the preliminary survey will be performed. For the Delphi process, stability will be checked by non-parametric chi-square (χ2) tests or Kruskal-Wallis test from round two onwards. A statement is said to be stable if p-value is > 0.05 for two consecutive rounds Consensus will be considered reached when a statement achieves >=75% of votes for multiple-choice questions and likert-scale statements. A statement will be continued in the questionnaire round until response stability is achieved. Consensus statements will be considered as those that generate both consensus and stability.