Journal article
Comparing videolaryngoscopy and flexible bronchoscopy to rescue failed direct laryngoscopy in children: a propensity score matched analysis of the Pediatric Difficult Intubation Registry
Anaesthesia, Vol.80(6), pp.625-635
06/2025
DOI: 10.1111/anae.16576
PMID: 40113331
Abstract
Flexible bronchoscopy is the gold standard for difficult airway management. Clinicians are using videolaryngoscopy increasingly because it is perceived to be easier to use with high success rates. We conducted this study to compare the success rates of the two techniques when used after failed direct laryngoscopy in children with difficult tracheal intubations.
We identified cases where initial attempts at direct laryngoscopy failed in the multicentre Pediatric Difficult Intubation Registry from August 2012-September 2023. After propensity score matching, we compared success rates and complications when videolaryngoscopy and flexible bronchoscopy were used as rescue techniques in the matched cohort and in matched patients weighing < 5 kg.
Clinicians chose videolaryngoscopy more frequently than flexible bronchoscopy when direct laryngoscopy failed (64.7%, 1426/2281 vs. 7.3%, 156/2281, p < 0.001). Propensity score matched cohorts did not differ with respect to first-attempt success, eventual success and complications. For the subgroup of infants < 5 kg, clinicians chose videolaryngoscopy more frequently than flexible bronchoscopy to rescue failed direct laryngoscopy (54.3%, 295/543 vs. 8.9%, 44/543, p < 0.001). First-attempt success was 43% (62/145) with videolaryngoscopy and 62% (18/29) with flexible bronchoscopy (odds ratio 2.19, 95%CI 0.96-4.98, p = 0.061). Eventual success was 71% (103/145) with videolaryngoscopy and 90% (26/29) with flexible bronchoscopy (odds ratio 3.53, 95%CI 1.03-12.2, p = 0.046). Complications did not differ between the techniques.
Videolaryngoscopy was chosen more frequently than flexible bronchoscopy as a rescue technique in a cohort of children with difficult direct laryngoscopy, with similar success and complication rates. For small infants, flexible bronchoscopy had a higher eventual success rate, underscoring the importance of maintaining proficiency with flexible bronchoscopy.
Details
- Title: Subtitle
- Comparing videolaryngoscopy and flexible bronchoscopy to rescue failed direct laryngoscopy in children: a propensity score matched analysis of the Pediatric Difficult Intubation Registry
- Creators
- Mary Lyn Stein - Boston Children's HospitalJulia Heunis Nagle - Boston Children's HospitalT Wesley Templeton - Wake Forest UniversitySteven J Staffa - Boston Children's HospitalStephen G Flynn - Boston Children's HospitalMartina Bordini - Hospital for Sick ChildrenSydney Nykiel-Bailey - Washington University in St. LouisAnnery G Garcia-Marcinkiewicz - Children's Hospital of PhiladelphiaFebina Padiyath - Children's Hospital of PhiladelphiaMaria Matuszczak - Texas Medical CenterAngela C Lee - George Washington UniversityJames M Peyton - Boston Children's HospitalRaymond S Park - Boston Children's HospitalBritta S von Ungern-Sternberg - The University of Western AustraliaPatrick N Olomu - University of IowaAgnes I Hunyady - Seattle Children's HospitalClyde Matava - Hospital for Sick ChildrenJohn E Fiadjoe - Children's Hospital of PhiladelphiaPete G Kovatsis - Boston Children's HospitalPeDI Collaborative
- Resource Type
- Journal article
- Publication Details
- Anaesthesia, Vol.80(6), pp.625-635
- DOI
- 10.1111/anae.16576
- PMID
- 40113331
- NLM abbreviation
- Anaesthesia
- ISSN
- 1365-2044
- eISSN
- 1365-2044
- Publisher
- WILEY
- Grant note
- Stan Perron Charitable Foundation
- Language
- English
- Electronic publication date
- 03/20/2025
- Date published
- 06/2025
- Academic Unit
- Anesthesia
- Record Identifier
- 9984801615502771
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