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Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject matter experts, informed by methodical review of available evidence and consensus among committee members. 

Algorithms associated with this Clinical Pathway: 

Inclusion criteria: 


  • History or physical exam findings suggesting DAI. 
  • ENT or anesthesia intubation or bronchoscopy findings of:  
    • Cormack-Lehane Grade III or IV Severe laryngeal papillomatosis.  
    • Severe subglottis stenosis.  
    • Severe tracheal stenosis. 
    • Difficult intubation for other reasons. 
  • SYNDROMES sometimes associated with a DAI:  
    • Pierre-Robin.  
    • Treacher Collins. 
    • Apert or Crouzon.  
    • Goldenhar.  
    • Choanal atresia.  
    • Campomelic dysplasia.
    • Hunter or Hurlers.  
    • Klippel-Feil . 
    • Muscular Dystrophy.  
    • Spinal Muscular Atrophy.  
    • VACTERL. 
    • Arthrogryposis multiplex.  
    • Morquio-Ulrich. 
    • Other syndromes with features suspicious for a DAI.  
  • FEATURES present with difficulty breathing:  
    • Difficult intubation.  
    • Micrognathia.  
    • Macroglossia. 
    • Limited neck range of motion or unstable C-spine.  
    • Head and/or neck radiation.  
    • A head and/or neck lesion.   
    • Other facial asymmetry or abnormalities. 

Team members involved in the development: 

  • K. Beaudet APRN | Ear, Nose and Throat (ENT) | Committee co-chair 
  • R. Quaile MSN, RN, FNP-BC | Ear, Nose and Throat (ENT) | Committee co-chair 
  • N. Campbell MD | Anesthesiology | Committee member 
  • S. Cornell APRN | Ear, Nose and Throat (ENT) | Committee member  
  • B. Gibson APRN, FNP-BC | Anesthesiology | Committee member 
  • S. Smith CPNP | Anesthesiology | Committee member 
  • R. Weatherly MD | Division Chief, ENT | Committee member 

Publication dates: 

  • Finalized date: August 2021; February 2022; July 2023 
  • Next expected revision date: July 2026

Concerns with content:

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These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.