Protocol for Chinese guidelines for perioperative airway management in thoracic surgery (2026 edition)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHI Xiuyi ¹ ,  LIU Lunxu ² ,  HE Jianxing ³ ,  CHE Guowei ^2,4 ,  HU Jian ⁵ , Writing Committee of Chinese Guidelines for Perioperative Airway Management in Thoracic Surgery (2026 edition) , Lung Cancer Medical Education Committee of China Medical Education Association

1. Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing, 100053, P. R. China;
2. Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, P. R. China;
4. Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, 610041, P. R. China;
5. Department of Thoracic Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310003, P. R. China;

Corresponding?author：

ZHI Xiuyi, Email: xiuyizhi2015@163.com; LIU Lunxu, Email: lunxu_liu@aliyun.com; HE Jianxing, Email: jianxinghe@gzhmu.edu.cn; CHE Guowei, Email: cheguoweixw@126.com; HU Jian, Email: hujian_med@163.com

Keywords：

Thoracic surgery; perioperative; airway management; enhanced recovery after surgery; guidelines; protocol; non-intubated minimally invasive; pulmonary rehabilitation

DOI：

10.7507/1007-4848.202604016

Video：

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Driven by the widespread adoption of minimally invasive thoracic surgical techniques and the deepening integration of enhanced recovery after surgery (ERAS) protocols, evidence-based perioperative airway management has emerged as a pivotal determinant of surgical safety, pulmonary functional recovery, and long-term prognosis. Currently, substantial regional disparities in thoracic surgical expertise persist across China, manifesting as heterogeneity in preoperative assessment standardization, inconsistent airway preparation strategies, divergent approaches to complication prevention, and limited penetration of advanced anesthetic technologies. To promote the standardization of clinical practices in this domain among hospitals at all levels, a multidisciplinary expert consortium has initiated the development of the Chinese Guidelines for Perioperative Airway Management in Thoracic Surgery (2026 edition). This protocol systematically delineates the methodological framework and structural blueprint underpinning the guideline’s formulation. Compared to the 2020 edition, the updated guideline places specific emphasis on refining stratified criteria for preoperative cardiopulmonary reserve assessment, establishing standardized management pathways for non-intubated spontaneous-ventilation techniques, formulating individualized multimodal perioperative pulmonary rehabilitation regimens, and defining precise intervention workflows for persistent postoperative cough. Collectively, these measures aim to further reduce the baseline incidence of perioperative pulmonary complications and to provide robust support for the clinical translation of enhanced recovery principles within the field of thoracic surgery.

Citation： ZHI Xiuyi, LIU Lunxu, HE Jianxing, CHE Guowei, HU Jian, Writing Committee of Chinese Guidelines for Perioperative Airway Management in Thoracic Surgery (2026 edition), Lung Cancer Medical Education Committee of China Medical Education Association. Protocol for Chinese guidelines for perioperative airway management in thoracic surgery (2026 edition). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(6): 894-899. doi: 10.7507/1007-4848.202604016 Copy

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19.	Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs, 2005, 14(7): 798-804.
20.	Lin R, Che G. Validation of the Mandarin Chinese version of the Leicester Cough Questionnaire in non-small cell lung cancer patients after surgery. Thorac Cancer, 2018, 9(4): 486-490.

1. Khallikane S, Seddiki R, Serghini I. Postoperative infectious pneumonia in cardiothoracic surgery: a systematic review and meta-analysis. F1000Res, 2025, 14: 588.
2. Guerrera F, Lyberis P, Lausi PO, et al. Does morbid obesity influence perioperative outcomes after video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer? Analysis of the Italian VATS group registry. Surg Endosc, 2022, 36(5): 3567-3573.
3. 支修益, 劉倫旭, 中國胸外科圍手術期氣道管理指南(2020版)編寫委員會. 中國胸外科圍手術期氣道管理指南(2020版). 中國胸心血管外科臨床雜志, 2021, 28(3): 251-262.Zhi XY, Liu LX, Writing Committee of Chinese Guidelines for Perioperative Airway Management in Thoracic Surgery (2020 edition). Chinese guidelines for perioperative airway management in thoracic surgery (2020 edition). Chin J Clin Thorac Cardiovasc Surg, 2021, 28(3): 251-262.
4. Elias KM, Brindle ME, Nelson G. Enhanced recovery after surgery-evidence and practice. NEJM Evid, 2025, 4(3): EVIDra2400012.
5. World Health Organization. WHO handbook for guideline development. 2nd ed. Geneva: WHO, 2014: 1-167.
6. Schünemann HJ, Wiercioch W, Etxeandia I, et al. Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ, 2014, 186(3): E123-E142.
7. 陳耀龍, 楊克虎, 王小欽, 等. 中國制訂/修訂臨床診療指南的指導原則(2022版). 中華醫學雜志, 2022, 102(10): 697-703.Chen YL, Yang KH, Wang XQ, et al. Principles and methods of development of Chinese clinical practice guidelines (2022 edition). Natl Med J China, 2022, 102(10): 697-703.
8. Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMJ, 2016, 352: i1152.
9. 楊楠, 趙巍, 潘旸, 等. 針對臨床實踐指南科學性、透明性和適用性的評級工具研發. 中華醫學雜志, 2022, 102(30): 2329-2337.Yang N, Zhao W, Pan Y, et al. Development of rankings tools for the scientificity, transparency, and applicability of clinical practice guidelines. Natl Med J China, 2022, 102(30): 2329-2337.
10. Chen Y, Yang K, Maru?ic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.
11. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or nonrandomized studies of healthcare interventions, or both. BMJ, 2017, 358: j4008.
12. Wang Y, Keitz S, Briel M, et al. Development of ROBUST-RCT: risk of bias instrument for use in systematic reviews for randomised controlled trials. BMJ, 2025, 388: e081199.
13. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ, 2016, 355: i4919.
14. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8): 529-536.
15. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
16. Rostom A, Dubé C, Cranney A, et al. Quality assessment forms. Rockville (MD): Agency for Healthcare Research and Quality (US), 2004.
17. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008, 336(7650): 924-926.
18. EuroQol Group. EuroQol: a new facility for the measurement of health-related quality of life. Health Policy, 1990, 16(3): 199-208.
19. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs, 2005, 14(7): 798-804.
20. Lin R, Che G. Validation of the Mandarin Chinese version of the Leicester Cough Questionnaire in non-small cell lung cancer patients after surgery. Thorac Cancer, 2018, 9(4): 486-490.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Protocol for Chinese guidelines for perioperative airway management in thoracic surgery (2026 edition)

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