Journal article
Efficacy of a hybrid technique of simultaneous videolaryngoscopy with flexible bronchoscopy in children with difficult direct laryngoscopy in the Pediatric Difficult Intubation Registry
Anaesthesia, Vol.78(9), pp.1093-1101
09/01/2023
DOI: 10.1111/anae.16049
PMID: 37322572
Abstract
Children with difficult tracheal intubation are at increased risk of severe complications, including hypoxaemia and cardiac arrest. Increasing experience with the simultaneous use of videolaryngoscopy and flexible bronchoscopy (hybrid) in adults led us to hypothesise that this hybrid technique could be used safely and effectively in children under general anaesthesia. We reviewed observational data from the international Pediatric Difficult Intubation Registry from 2017 to 2021 to assess the safety and efficacy of hybrid tracheal intubation approaches in paediatric patients. In total, 140 patients who underwent 180 attempts at tracheal intubation with the hybrid technique were propensity score-matched 4:1 with 560 patients who underwent 800 attempts with a flexible bronchoscope. In the hybrid group, first attempt success was 70% (98/140) compared with 63% (352/560) in the flexible bronchoscope group (odds ratio (95%CI) 1.4 (0.9-2.1), p = 0.1). Eventual success rates in the matched groups were 90% (126/140) for hybrid vs. 89% (499/560) for flexible bronchoscope (1.1 (0.6-2.1), p = 0.8). Complication rates were similar in both groups (15% (28 complications in 182 attempts) hybrid; 13% (102 complications in 800 attempts) flexible bronchoscope, p = 0.3). The hybrid technique was more likely than flexible bronchoscopy to be used as a rescue technique following the failure of another technique (39% (55/140) vs. 25% (138/560), 2.1 (1.4-3.2) p < 0.001). While technically challenging, the hybrid technique has success rates similar to other advanced airway techniques, few complications and may be considered an alternative technique when developing an airway plan for paediatric patients whose tracheas are difficult to intubate under general anaesthesia.
Details
- Title: Subtitle
- Efficacy of a hybrid technique of simultaneous videolaryngoscopy with flexible bronchoscopy in children with difficult direct laryngoscopy in the Pediatric Difficult Intubation Registry
- Creators
- M. L. Stein - Boston Children's HospitalR. S. Park - Boston Children's HospitalE. E. Kiss - The University of Texas Southwestern Medical CenterH. D. Adams - Children's Hospital of Los AngelesN. E. Burjek - Lurie Children's HospitalJ. Peyton - Boston Children's HospitalP. Szmuk - The University of Texas Southwestern Medical CenterS. J. Staffa - Boston Children's HospitalJ. E. Fiadjoe - Boston Children's HospitalP. G. Kovatsis - Boston Children's HospitalP. N. Olomu - The University of Texas Southwestern Medical CenterPeDI Collaborative Investigators
- Resource Type
- Journal article
- Publication Details
- Anaesthesia, Vol.78(9), pp.1093-1101
- Publisher
- Wiley
- DOI
- 10.1111/anae.16049
- PMID
- 37322572
- ISSN
- 0003-2409
- eISSN
- 1365-2044
- Number of pages
- 9
- Language
- English
- Date published
- 09/01/2023
- Academic Unit
- Anesthesia
- Record Identifier
- 9984656530702771
Metrics
4 Record Views