Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry

BACKGROUND:The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficu...

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Published inAnesthesiology (Philadelphia) Vol. 127; no. 3; pp. 432 - 440
Main Authors Burjek, Nicholas E., Nishisaki, Akira, Fiadjoe, John E., Adams, H. Daniel, Peeples, Kenneth N., Raman, Vidya T., Olomu, Patrick N., Kovatsis, Pete G., Jagannathan, Narasimhan, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Hopkins, Paul, Glover, Chris, Olutoye, Olutoyin, Szmuk, Peter, McCloskey, John, Dalesio, Nicholas, Koka, Rahul, Greenberg, Robert, Watkins, Scott, Patel, Vikram, Reynolds, Paul, Matuszczak, Maria, Jain, Ranu, Khalil, Samia, Polaner, David, Zieg, Jennifer, Szolnoki, Judit, Sathyamoorthy, Kumar, Taicher, Brad, Riveros Perez, N. Ricardo, Bhattacharya, Solmaletha, Bhalla, Tarun, Stricker, Paul, Lockman, Justin, Galvez, Jorge, Rehman, Mohamed, Von Ungern-Sternberg, Britta, Sommerfield, David, Soneru, Codruta, Chiao, Franklin, Richtsfeld, Martina, Belani, Kumar, Sarmiento, Lina, Mireles, Sam, Bilen Rosas, Guelay, Park, Raymond, Peyton, James
Format Journal Article
LanguageEnglish
Published United States Copyright by , the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc 01.09.2017
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Abstract BACKGROUND:The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques. METHODS:Observational data were collected from 14 sites after management of difficult pediatric airways. Patient age, intubation technique, success per attempt, use of continuous ventilation, and complications were recorded for each case. First-attempt success and complications were compared in subjects managed with fiber-optic intubation via supraglottic airway and videolaryngoscopy. RESULTS:Fiber-optic intubation via supraglottic airway and videolaryngoscopy had similar first-attempt success rates (67 of 114, 59% vs. 404 of 786, 51%; odds ratio 1.35; 95% CI, 0.91 to 2.00; P = 0.16). In subjects less than 1 yr old, fiber-optic intubation via supraglottic airway was more successful on the first attempt than videolaryngoscopy (19 of 35, 54% vs. 79 of 220, 36%; odds ratio, 2.12; 95% CI, 1.04 to 4.31; P = 0.042). Complication rates were similar in the two groups (20 vs. 13%; P = 0.096). The incidence of hypoxemia was lower when continuous ventilation through the supraglottic airway was used throughout the fiber-optic intubation attempt. CONCLUSIONS:In this nonrandomized study, first-attempt success rates were similar for fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway is associated with higher first-attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.
AbstractList The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques. Observational data were collected from 14 sites after management of difficult pediatric airways. Patient age, intubation technique, success per attempt, use of continuous ventilation, and complications were recorded for each case. First-attempt success and complications were compared in subjects managed with fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway and videolaryngoscopy had similar first-attempt success rates (67 of 114, 59% vs. 404 of 786, 51%; odds ratio 1.35; 95% CI, 0.91 to 2.00; P = 0.16). In subjects less than 1 yr old, fiber-optic intubation via supraglottic airway was more successful on the first attempt than videolaryngoscopy (19 of 35, 54% vs. 79 of 220, 36%; odds ratio, 2.12; 95% CI, 1.04 to 4.31; P = 0.042). Complication rates were similar in the two groups (20 vs. 13%; P = 0.096). The incidence of hypoxemia was lower when continuous ventilation through the supraglottic airway was used throughout the fiber-optic intubation attempt. In this nonrandomized study, first-attempt success rates were similar for fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway is associated with higher first-attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.
The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques.BACKGROUNDThe success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques.Observational data were collected from 14 sites after management of difficult pediatric airways. Patient age, intubation technique, success per attempt, use of continuous ventilation, and complications were recorded for each case. First-attempt success and complications were compared in subjects managed with fiber-optic intubation via supraglottic airway and videolaryngoscopy.METHODSObservational data were collected from 14 sites after management of difficult pediatric airways. Patient age, intubation technique, success per attempt, use of continuous ventilation, and complications were recorded for each case. First-attempt success and complications were compared in subjects managed with fiber-optic intubation via supraglottic airway and videolaryngoscopy.Fiber-optic intubation via supraglottic airway and videolaryngoscopy had similar first-attempt success rates (67 of 114, 59% vs. 404 of 786, 51%; odds ratio 1.35; 95% CI, 0.91 to 2.00; P = 0.16). In subjects less than 1 yr old, fiber-optic intubation via supraglottic airway was more successful on the first attempt than videolaryngoscopy (19 of 35, 54% vs. 79 of 220, 36%; odds ratio, 2.12; 95% CI, 1.04 to 4.31; P = 0.042). Complication rates were similar in the two groups (20 vs. 13%; P = 0.096). The incidence of hypoxemia was lower when continuous ventilation through the supraglottic airway was used throughout the fiber-optic intubation attempt.RESULTSFiber-optic intubation via supraglottic airway and videolaryngoscopy had similar first-attempt success rates (67 of 114, 59% vs. 404 of 786, 51%; odds ratio 1.35; 95% CI, 0.91 to 2.00; P = 0.16). In subjects less than 1 yr old, fiber-optic intubation via supraglottic airway was more successful on the first attempt than videolaryngoscopy (19 of 35, 54% vs. 79 of 220, 36%; odds ratio, 2.12; 95% CI, 1.04 to 4.31; P = 0.042). Complication rates were similar in the two groups (20 vs. 13%; P = 0.096). The incidence of hypoxemia was lower when continuous ventilation through the supraglottic airway was used throughout the fiber-optic intubation attempt.In this nonrandomized study, first-attempt success rates were similar for fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway is associated with higher first-attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.CONCLUSIONSIn this nonrandomized study, first-attempt success rates were similar for fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway is associated with higher first-attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.
BACKGROUND:The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this study is to compare the success rates of fiber-optic intubation via supraglottic airway to videolaryngoscopy in children with difficult airways. Our secondary aim is to compare the complication rates of these techniques. METHODS:Observational data were collected from 14 sites after management of difficult pediatric airways. Patient age, intubation technique, success per attempt, use of continuous ventilation, and complications were recorded for each case. First-attempt success and complications were compared in subjects managed with fiber-optic intubation via supraglottic airway and videolaryngoscopy. RESULTS:Fiber-optic intubation via supraglottic airway and videolaryngoscopy had similar first-attempt success rates (67 of 114, 59% vs. 404 of 786, 51%; odds ratio 1.35; 95% CI, 0.91 to 2.00; P = 0.16). In subjects less than 1 yr old, fiber-optic intubation via supraglottic airway was more successful on the first attempt than videolaryngoscopy (19 of 35, 54% vs. 79 of 220, 36%; odds ratio, 2.12; 95% CI, 1.04 to 4.31; P = 0.042). Complication rates were similar in the two groups (20 vs. 13%; P = 0.096). The incidence of hypoxemia was lower when continuous ventilation through the supraglottic airway was used throughout the fiber-optic intubation attempt. CONCLUSIONS:In this nonrandomized study, first-attempt success rates were similar for fiber-optic intubation via supraglottic airway and videolaryngoscopy. Fiber-optic intubation via supraglottic airway is associated with higher first-attempt success than videolaryngoscopy in infants with difficult airways. Continuous ventilation through the supraglottic airway during fiber-optic intubation attempts may lower the incidence of hypoxemia.
Author Peeples, Kenneth N.
Olomu, Patrick N.
Watkins, Scott
Richtsfeld, Martina
Zieg, Jennifer
Khalil, Samia
Belani, Kumar
Bosenberg, Adrian
Mireles, Sam
Jagannathan, Narasimhan
Szmuk, Peter
Polaner, David
Bhalla, Tarun
Stricker, Paul
Fiadjoe, John E.
Glover, Chris
Dalesio, Nicholas
Greenberg, Robert
Nishisaki, Akira
Olutoye, Olutoyin
Kovatsis, Pete G.
Matuszczak, Maria
Soneru, Codruta
Bilen Rosas, Guelay
Sommerfield, David
Reynolds, Paul
Galvez, Jorge
Peyton, James
Chiao, Franklin
Adams, H. Daniel
Szolnoki, Judit
Rehman, Mohamed
Von Ungern-Sternberg, Britta
Tham, See
Burjek, Nicholas E.
McCloskey, John
Koka, Rahul
Lockman, Justin
Raman, Vidya T.
Riveros Perez, N. Ricardo
Park, Raymond
Patel, Vikram
Hopkins, Paul
Jain, Ranu
Taicher, Brad
Sathyamoorthy, Kumar
Sarmiento, Lina
Hunyady, Agnes
Low, Daniel
Bhattacharya, Solmaletha
AuthorAffiliation From the Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (N.E.B., N.J.); Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (A.N., J.E.F., K.N.P.); Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida (H.D.A.); Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio (V.T.R.); Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas (P.N.O.); and Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts (P.G.K.). Department of Anesthesiology and Pain Medicine, Seattle Children’s H
AuthorAffiliation_xml – name: From the Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (N.E.B., N.J.); Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (A.N., J.E.F., K.N.P.); Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida (H.D.A.); Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio (V.T.R.); Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas (P.N.O.); and Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts (P.G.K.). Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, Children’s Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, Children’s Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, Children’s Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi Department of Anesthesiology, Duke University, Durham, North Carolina Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio Department of Anesthesia, Critical Care and Pain, Massachusetts General Hospital, Boston, Massachusetts Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia Department of Anesthesiology, University of New Mexico, Albuquerque, New Mexico Department of Anesthesiology, Weill Cornell Medical College, New York, New York Dep.artment of Anesthesiology, University of Minnesota, Minneapolis, Minnesota Dep.artment of Anesthesiology, University of Minnesota, Minneapolis, Minnesota Department of Anesthesiology, National Institute of Pediatrics, Mexico City, Mexico Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
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  organization: From the Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (N.E.B., N.J.); Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (A.N., J.E.F., K.N.P.); Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida (H.D.A.); Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio (V.T.R.); Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas (P.N.O.); and Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts (P.G.K.). Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas Department of Anesthesiology, Children’s Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, Children’s Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, Children’s Hospital of Colorado, Aurora, Colorado Department of Anesthesiology, University of Mississippi Medical Center, Jackson, Mississippi Department of Anesthesiology, Duke University, Durham, North Carolina Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio Department of Anesthesia, Critical Care and Pain, Massachusetts General Hospital, Boston, Massachusetts Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia Department of Anesthesiology, University of New Mexico, Albuquerque, New Mexico Department of Anesthesiology, Weill Cornell Medical College, New York, New York Dep.artment of Anesthesiology, University of Minnesota, Minneapolis, Minnesota Dep.artment of Anesthesiology, University of Minnesota, Minneapolis, Minnesota Department of Anesthesiology, National Institute of Pediatrics, Mexico City, Mexico Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/28650415$$D View this record in MEDLINE/PubMed
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Snippet BACKGROUND:The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim...
The success rates and related complications of various techniques for intubation in children with difficult airways remain unknown. The primary aim of this...
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SubjectTerms Child
Child, Preschool
Equipment Design
Female
Fiber Optic Technology
Humans
Infant
Intubation, Intratracheal - instrumentation
Intubation, Intratracheal - methods
Laryngoscopes
Laryngoscopy - instrumentation
Laryngoscopy - methods
Male
Registries - statistics & numerical data
Videotape Recording
Title Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry
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