TY - JOUR
T1 - Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway
T2 - An Analysis from the Multicenter Pediatric Difficult Intubation Registry
AU - PeDI Collaborative Investigators
AU - Burjek, Nicholas E.
AU - Nishisaki, Akira
AU - Fiadjoe, John E.
AU - Adams, H. Daniel
AU - Peeples, Kenneth N.
AU - Raman, Vidya T.
AU - Olomu, Patrick N.
AU - Kovatsis, Pete G.
AU - Jagannathan, Narasimhan
AU - Hunyady, Agnes
AU - Bosenberg, Adrian
AU - Tham, See
AU - Low, Daniel
AU - Hopkins, Paul
AU - Glover, Chris
AU - Olutoye, Olutoyin
AU - Szmuk, Peter
AU - McCloskey, John
AU - Dalesio, Nicholas
AU - Koka, Rahul
AU - Greenberg, Robert
AU - Watkins, Scott
AU - Patel, Vikram
AU - Reynolds, Paul
AU - Matuszczak, Maria
AU - Jain, Ranu
AU - Khalil, Samia
AU - Polaner, David
AU - Zieg, Jennifer
AU - Szolnoki, Judit
AU - Sathyamoorthy, Kumar
AU - Taicher, Brad
AU - Perez, N. Ricardo Riveros
AU - Bhattacharya, Solmaletha
AU - Bhalla, Tarun
AU - Stricker, Paul
AU - Lockman, Justin
AU - Galvez, Jorge
AU - Rehman, Mohamed
AU - Von Ungern-Sternberg, Britta
AU - Sommerfield, David
AU - Soneru, Codruta
AU - Chiao, Franklin
AU - Richtsfeld, Martina
AU - Belani, Kumar
AU - Sarmiento, Lina
AU - Mireles, Sam
AU - Rosas, Guelay Bilen
AU - Park, Raymond
AU - Peyton, James
N1 - Publisher Copyright:
© Copyright 2017, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - 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.
AB - 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.
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U2 - 10.1097/ALN.0000000000001758
DO - 10.1097/ALN.0000000000001758
M3 - Article
C2 - 28650415
AN - SCOPUS:85021259541
SN - 0003-3022
VL - 127
SP - 432
EP - 440
JO - Anesthesiology
JF - Anesthesiology
IS - 3
ER -