R Park1,2, J M Peyton1,2, J E Fiadjoe3, A I Hunyady4, T Kimball1, D Zurakowski1,2, P G Kovatsis1,2. 1. Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA. 2. Department of Anaesthesiology, Harvard Medical School, Boston, MA, USA. 3. Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 4. Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
Abstract
BACKGROUND: We analysed data from the Paediatric Difficult Intubation Registry examining the use of direct laryngoscopy and GlideScope® videolaryngoscopy. METHODS: Data collected by a multicentre, paediatric difficult intubation registry from 1295 patients were analysed. Rates of success and complications between direct laryngoscopy and GlideScope videolaryngoscopy were analysed. RESULTS: Initial (464/877 = 53% vs 33/828 = 4%, Z-test = 22.2, P < 0.001) and eventual (720/877 = 82% vs. 174/828 = 21%, Z-test = 25.2, P < 0.001) success rates for GlideScope were significantly higher than direct laryngoscopy. Children weighing <10 kg had lower success rates with the GlideScope than the group as a whole. There were no differences in complication rates per attempt between direct laryngoscopy and GlideScope. The direct laryngoscopy group had more complications associated with the greater number of attempts needed to intubate. There were no increased risks of hypoxia or trauma with GlideScope use. Each additional attempt at intubation with either device resulted in a two-fold increase in complications (odds ratio: 2.0, 95% confidence interval: 1.5-2.5, P < 0.001). CONCLUSIONS: During difficult tracheal intubation in children, direct laryngoscopy is an overly used technique with a low chance of success. GlideScope use was associated with a higher chance of success with no increased risk of complications. GlideScope use in children with difficult tracheal intubation has a lower success rate than in adults with difficult tracheal intubation. Children weighing less than 10 kilograms had lower success rates with either device. Attempts should be minimized with either device to decrease complications.
BACKGROUND: We analysed data from the Paediatric Difficult Intubation Registry examining the use of direct laryngoscopy and GlideScope® videolaryngoscopy. METHODS: Data collected by a multicentre, paediatric difficult intubation registry from 1295 patients were analysed. Rates of success and complications between direct laryngoscopy and GlideScope videolaryngoscopy were analysed. RESULTS: Initial (464/877 = 53% vs 33/828 = 4%, Z-test = 22.2, P < 0.001) and eventual (720/877 = 82% vs. 174/828 = 21%, Z-test = 25.2, P < 0.001) success rates for GlideScope were significantly higher than direct laryngoscopy. Children weighing <10 kg had lower success rates with the GlideScope than the group as a whole. There were no differences in complication rates per attempt between direct laryngoscopy and GlideScope. The direct laryngoscopy group had more complications associated with the greater number of attempts needed to intubate. There were no increased risks of hypoxia or trauma with GlideScope use. Each additional attempt at intubation with either device resulted in a two-fold increase in complications (odds ratio: 2.0, 95% confidence interval: 1.5-2.5, P < 0.001). CONCLUSIONS: During difficult tracheal intubation in children, direct laryngoscopy is an overly used technique with a low chance of success. GlideScope use was associated with a higher chance of success with no increased risk of complications. GlideScope use in children with difficult tracheal intubation has a lower success rate than in adults with difficult tracheal intubation. Children weighing less than 10 kilograms had lower success rates with either device. Attempts should be minimized with either device to decrease complications.
Authors: Maciej Maslanka; Lukasz Szarpak; Sanchit Ahuja; Kurt Ruetzler; Jacek Smereka Journal: Medicine (Baltimore) Date: 2020-07-10 Impact factor: 1.817
Authors: Clyde T Matava; Pete G Kovatsis; Jennifer K Lee; Pilar Castro; Simon Denning; Julie Yu; Raymond Park; Justin L Lockman; Britta Von Ungern-Sternberg; Stefano Sabato; Lisa K Lee; Ihab Ayad; Sam Mireles; David Lardner; Simon Whyte; Judit Szolnoki; Narasimhan Jagannathan; Nicole Thompson; Mary Lyn Stein; Nicholas Dalesio; Robert Greenberg; John McCloskey; James Peyton; Faye Evans; Bishr Haydar; Paul Reynolds; Franklin Chiao; Brad Taicher; Thomas Templeton; Tarun Bhalla; Vidya T Raman; Annery Garcia-Marcinkiewicz; Jorge Gálvez; Jonathan Tan; Mohamed Rehman; Christy Crockett; Patrick Olomu; Peter Szmuk; Chris Glover; Maria Matuszczak; Ignacio Galvez; Agnes Hunyady; David Polaner; Cheryl Gooden; Grace Hsu; Harshad Gumaney; Caroline Pérez-Pradilla; Edgar E Kiss; Mary C Theroux; Jennifer Lau; Saeedah Asaf; Pablo Ingelmo; Thomas Engelhardt; Mónica Hervías; Eric Greenwood; Luv Javia; Nicola Disma; Myron Yaster; John E Fiadjoe Journal: Anesth Analg Date: 2020-07 Impact factor: 5.108
Authors: J Adam Law; Laura V Duggan; Mathieu Asselin; Paul Baker; Edward Crosby; Andrew Downey; Orlando R Hung; Philip M Jones; François Lemay; Rudiger Noppens; Matteo Parotto; Roanne Preston; Nick Sowers; Kathryn Sparrow; Timothy P Turkstra; David T Wong; George Kovacs Journal: Can J Anaesth Date: 2021-06-18 Impact factor: 5.063