Journal article
Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry
British journal of anaesthesia : BJA, Vol.131(1), pp.178-187
07/2023
DOI: 10.1016/j.bja.2023.02.035
PMID: 37076335
Abstract
Difficult facemask ventilation is perilous in children whose tracheas are difficult to intubate. We hypothesised that certain physical characteristics and anaesthetic factors are associated with difficult mask ventilation in paediatric patients who also had difficult tracheal intubation.
We queried a multicentre registry for children who experienced "difficult" or "impossible" facemask ventilation. Patient and case factors known before mask ventilation attempt were included for consideration in this regularised multivariable regression analysis. Incidence of complications, and frequency and efficacy of rescue placement of a supraglottic airway device were also tabulated. Changes in quality of mask ventilation after injection of a neuromuscular blocking agent were assessed.
The incidence of difficult mask ventilation was 9% (483 of 5453 patients). Infants and patients having increased weight, being less than 5th percentile in weight for age, or having Treacher-Collins syndrome, glossoptosis, or limited mouth opening were more likely to have difficult mask ventilation. Anaesthetic induction using facemask and opioids was associated with decreased risk of difficult mask ventilation. The incidence of complications was significantly higher in patients with "difficult" mask ventilation than in patients without. Rescue placement of a supraglottic airway improved ventilation in 71% (96 of 135) of cases. Administration of neuromuscular blocking agents was more frequently associated with improvement or no change in quality of ventilation than with worsening.
Certain abnormalities on physical examination should increase suspicion of possible difficult facemask ventilation. Rescue use of a supraglottic airway device in children with difficult or impossible mask ventilation should be strongly considered.
Details
- Title: Subtitle
- Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry
- Creators
- Annery G Garcia-Marcinkiewicz - Children's Hospital of PhiladelphiaLisa K Lee - University of California, Los AngelesBishr Haydar - University of Michigan–Ann ArborJohn E Fiadjoe - Harvard UniversityClyde T Matava - Hospital for Sick ChildrenPete G Kovatsis - Boston Children's HospitalJames Peyton - Boston Children's HospitalMary L Stein - Boston Children's HospitalRaymond Park - Boston Children's HospitalBrad M Taicher - Duke Children's Hospital & Health CenterThomas W Templeton - Wake Forest UniversityPaediatric Difficult Intubation (PeDI) CollaborativePatrick N Olomu (Contributor) - Anesthesia
- Resource Type
- Journal article
- Publication Details
- British journal of anaesthesia : BJA, Vol.131(1), pp.178-187
- DOI
- 10.1016/j.bja.2023.02.035
- PMID
- 37076335
- ISSN
- 0007-0912
- eISSN
- 1471-6771
- Language
- English
- Date published
- 07/2023
- Academic Unit
- Anesthesia
- Record Identifier
- 9984656596302771
Metrics
5 Record Views