As opposed to the simplistic promotion of one given technique or device, the multimodal airway management relies on the recognition that each individual approach may fail, that the maintenance of oxygenation during the procedure is a key point, that the prerequisites to the practical step of placing a tube in the trachea involve the knowledge of intelligent and intelligible algorithms and the previous acquisition of skills, with understanding of their foundations. An example of the ‘combination techniques’ using the specific advantages of one medical device to mitigate the limitations of another is the use of a videolaryngoscope to facilitate intubation with a flexible optical bronchoscope, which increases the ease and the success of the process during the clinical as well as the training phases. Other multimodal approaches such as the combination of bronchoscopy with the use of a supraglottic airway or with high flow nasal oxygen optimise the safety of the procedure by maintaining the delivery of oxygen. The multimodal approach is particularly useful for the anaesthesiologist and intensivist only occasionally exposed to the management of difficult airway situations. It improves high quality care of patients, education and training.

Failure to properly assess and identify possible difficulties with airway management and incorporate these findings to airway management strategies can lead to a poor clinical outcome. A thorough patient history review and physical examination, including bedside airway assessment, often reveal either congenital or acquired clinical conditions that may affect airway management. Ultrasound, radiographic studies and bedside flexible endoscopy for airway assessment are often necessary to understand the mechanism of pathophysiology of the lower airway. The advancement of technology, such as three-dimensional imaging, cone-beam computer tomography and virtual endoscopy, etc., is resulting in the emergence of potential future airway assessment tools. However, the ideal assessment tool for difficult airway management does not exist and unanticipated difficulties often occur. Using multiple tests to predict difficulty in airway management is better than any single test used in isolation. In addition, adverse human factors can significantly impact airway management. The importance of incorporating cognitive aids in our routine practice cannot be underestimated. Airway assessment forms the first part of any airway management strategy, including the use of certain medications and airway techniques. As practitioners, we must rise to the occasion and perform best clinical practice; there can no longer be a disconnect in what we know and what we do. We need to be the strong link in the chain in providing safe and quality care for our patients.