1. Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway
- Author
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Adrian T. Bosenberg, Nicholas E. Burjek, Daniel Low, Vidya T. Raman, Ranu Jain, Kumar G. Belani, See Tham, Maria Matuszczak, Robert S. Greenberg, Vikram Patel, Lina Sarmiento, H. Daniel Adams, PeDI Collaborative Investigators, Tarun Bhalla, Chris D. Glover, Scott C. Watkins, Solmaletha Bhattacharya, John J. McCloskey, Judit Szolnoki, Sam Mireles, Guelay Bilen Rosas, N. Ricardo Riveros Perez, Paul A. Stricker, Peter Szmuk, Paul I. Reynolds, Rahul Koka, Pete G. Kovatsis, Martina Richtsfeld, James Peyton, Akira Nishisaki, John E. Fiadjoe, Jennifer Zieg, Samia N. Khalil, Paul Hopkins, Raymond Park, Patrick Olomu, David M. Polaner, Britta S. von Ungern-Sternberg, Justin L. Lockman, Codruta Soneru, Jorge A. Gálvez, Franklin Chiao, Nicholas M. Dalesio, Narasimhan Jagannathan, Kumar Sathyamoorthy, Brad M. Taicher, David Sommerfield, Agnes Hunyady, Kenneth N. Peeples, Olutoyin A. Olutoye, and Mohamed A. Rehman
- Subjects
business.industry ,medicine.medical_treatment ,030208 emergency & critical care medicine ,Endotracheal intubation ,Supraglottic airway ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Multicenter study ,030202 anesthesiology ,Anesthesia ,medicine ,Intubation ,business ,Difficult airway ,Difficult intubation - Abstract
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.
- Published
- 2017