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1. Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time.

Author

Stein, Mary, Sarmiento Argüello, Lina, Staffa, Steven, Heunis, Julia, Egbuta, Chinyere, Flynn, Stephen, Khan, Sabina, Sabato, Stefano, Taicher, Brad, Chiao, Franklin, Bosenberg, Adrian, Lee, Angela, Adams, H, von Ungern-Sternberg, Britta, Park, Raymond, Peyton, James, Olomu, Patrick, Hunyady, Agnes, Garcia-Marcinkiewicz, Annery, Fiadjoe, John, and Kovatsis, Pete

Subjects
Complications, Difficult airway, Intubation, Outcomes, Paediatric airway, Video laryngoscopy
Abstract

BACKGROUND: The Paediatric Difficult Intubation Collaborative identified multiple attempts and persistence with direct laryngoscopy as risk factors for complications in children with difficult tracheal intubations and subsequently engaged in initiatives to reduce repeated attempts and persistence with direct laryngoscopy in children. We hypothesised these efforts would lead to fewer attempts, fewer direct laryngoscopy attempts and decrease complications. METHODS: Paediatric patients less than 18 years of age with difficult direct laryngoscopy were enrolled in the Paediatric Difficult Intubation Registry. We define patients with difficult direct laryngoscopy as those in whom (1) an attending or consultant obtained a Cormack Lehane Grade 3 or 4 view on direct laryngoscopy, (2) limited mouth opening makes direct laryngoscopy impossible, (3) direct laryngoscopy failed in the preceding 6 months, and (4) direct laryngoscopy was deferred due to perceived risk of harm or poor chance of success. We used a 5:1 propensity score match to compare an early cohort from the initial Paediatric Difficult Intubation Registry analysis (August 6, 2012-January 31, 2015, 785 patients, 13 centres) and a current cohort from the Registry (March 4, 2017-March 31, 2023, 3925 patients, 43 centres). The primary outcome was first attempt success rate between cohorts. Success was defined as confirmed endotracheal intubation and assessed by the treating clinician. Secondary outcomes were eventual success rate, number of attempts at intubation, number of attempts with direct laryngoscopy, the incidence of persistence with direct laryngoscopy, use of supplemental oxygen, all complications, and severe complications. FINDINGS: First-attempt success rate was higher in the current cohort (42% vs 32%, OR 1.5 95% CI 1.3-1.8, p

Published
2024

2. Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry

Author

Garcia-Marcinkiewicz, Annery G, Lee, Lisa K, Haydar, Bishr, Fiadjoe, John E, Matava, Clyde T, Kovatsis, Pete G, Peyton, James, Stein, Mary L, Park, Raymond, Taicher, Brad M, Templeton, Thomas W, Collaborative, on behalf of the PeDI, Bruins, Benjamin B, Stricker, Paul, Laverriere, Elizabeth K, Lockman, Justin L, Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Guris, Rodrigo J Daly, Sequera-Ramos, Luis, Teen, Mark S, Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Goldfarb, Tally, Kiss, Edgar E, Olomu, Patrick N, Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Holmes, Christopher, Sabato, Stefan, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Reynolds, Paul, Lewis, Ian, Schrock, Charles, Nykiel-Bailey, Sydney, Starker, Elizabeth, Szolnoki, Judit, Brooks-Peterson, Melissa, Bhattacharya, Somaletha, Burjek, Nicholas E, Jagannathan, Narasimhan, Lardner, David, Watkins, Scott, Crockett, Christy, Moore, John, Robertson, Sara, Sathyamoorthy, Madhankumar, Chiao, Franklin, Patel, Jasmine, Sharma, Aarti, Marin, Piedad Echeverry, Pérez-Pradilla, Carolina, Singh, Neeta, von Ungern-Sternberg, Britta S, Sommerfield, David, Bilen-Rosas, Guelay, Lewkowitz-Shpuntoff, Hilana, Castro, Pilar, Perez, N Ricardo Riveros, de Graaff, Jurgen C, Vega, Eduardo, González, Alejandro, Ostermann, Paola, Rubin, Kasia, Lord, Charles, Lee, Angela, Heitmiller, Eugenie, Valairucha, Songyos, Dalal, Priti, Tran, Thanh, Ayad, Ihab, Rehman, Mohamed, Fernandez, Allison, Zamora, Lillian, Ravula, Niroop, and Shaik, Sadiq

Subjects
Rare Diseases, Lung, Assistive Technology, Bioengineering, Infant, Humans, Child, Masks, Intubation, Intratracheal, Retrospective Studies, Respiration, Laryngeal Masks, Airway Management, complications, difficult airway, difficult facemask ventilation, impossible facemask ventilation, paediatrics, supraglottic airway, PeDI Collaborative, Clinical Sciences, Anesthesiology
Abstract

BackgroundDifficult 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.MethodsWe 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.ResultsThe 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.ConclusionsCertain 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.

Published
2023

3. Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time

Author

Bruins, Benjamin, Stricker, Paul, Laverriere, Elizabeth, Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Guris, Rodrigo Daly, Sequera-Ramos, Luis, Teen, Mark, Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Battles, Rhae, Bocanegra, Ashley, Goldfarb, Tally, Kiss, Edgar, Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Holmes, Christopher, McCann, Alexander, Matava, Clyde, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Desai, Sapna, Rosander, Sondra, Samba, Sindhu, Schrock, Charles, Nykiel-Bailey, Sydney, Marsh, Jennifer, Peterson, Melissa Brooks, Lee, Amy, Bhattacharya, Somaletha, Burjek, Nicholas, Jagannathan, Narasimhan, Lardner, David, Crockett, Christy, Robetson, Sara, Patel, Jasmine, Sharma, Aarti, Templeton, Thomas, Marín, Piedad Echeverry, Pérez-Pradilla, Carolina, Singh, Neeta, Sommerfield, David, Hauser, Neil, Hesselink, Emily, Lewkowitz-Shpuntoff, Hilana, Castro, Pilar, Riveros Perez, N. Ricardo, Vega, Eduardo, González, Alejandro, Ostermann, Paola, Rubin, Kasia, Meserve, Jonathan, Lord, Charles, Lee, Angela, Valairucha, Songyos, Dalal, Priti, Tran, Thanh, Anspach, Taylor, Lee, Lisa K., Ayad, Ihab, Rehman, Mohamed, Fernandez, Allison, Zamora, Lillian, Ravula, Niroop, Shaik, Sadiq, Szolnoki, Judit, Mathew, Preethy, Yaddanapudi, Sandhya, Sen, Indu, Gupta, Aakriti, Handlogten, Kathryn, Sroka, J. Michael, Quintão, Vinícius Caldeira, Carlos, Ricardo Vieira, Leite, Fernanda, Stein, Mary Lyn, Sarmiento Argüello, Lina Andrea, Staffa, Steven J., Heunis, Julia, Egbuta, Chinyere, Flynn, Stephen G., Khan, Sabina A., Sabato, Stefano, Taicher, Brad M., Chiao, Franklin, Bosenberg, Adrian, Lee, Angela C., Adams, H. Daniel, von Ungern-Sternberg, Britta S., Park, Raymond S., Peyton, James M., Olomu, Patrick N., Hunyady, Agnes I., Garcia-Marcinkiewicz, Annery, Fiadjoe, John E., and Kovatsis, Pete G.

Published
2024
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5. Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines

Author

Srinivasan, Ilavajady, Correia, Michelle, Nghiem, Jessica, Chowdhury, Apala R., Marchesini, Vanessa, Bonfiglio, Rachele, Bastianello, Matilde, Disma, Nicola, Asai, Takashi, Cools, Evelien, Cronin, Alexandria, Engelhardt, Thomas, Fiadjoe, John, Fuchs, Alexander, Garcia-Marcinkiewicz, Annery, Habre, Walid, Heath, Chloe, Johansen, Mathias, Kaufmann, Jost, Kleine-Brueggeney, Maren, Kovatsis, Pete G., Kranke, Peter, Lusardi, Andrea C., Matava, Clyde, Peyton, James, Riva, Thomas, Romero, Carolina S., von Ungern-Sternberg, Britta, Veyckemans, Francis, and Afshari, Arash

Published
2024
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6. Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry

Author

Bruins, Benjamin B., Stricker, Paul, Laverriere, Elizabeth K., Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Daly Guris, Rodrigo J., Sequera-Ramos, Luis, Teen, Mark S., Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Goldfarb, Tally, Kiss, Edgar E., Olomu, Patrick N., Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Holmes, Christopher, Sabato, Stefan, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Reynolds, Paul, Lewis, Ian, Schrock, Charles, Nykiel-Bailey, Sydney, Starker, Elizabeth, Szolnoki, Judit, Brooks-Peterson, Melissa, Bhattacharya, Somaletha, Burjek, Nicholas E., Jagannathan, Narasimhan, Lardner, David, Watkins, Scott, Crockett, Christy, Moore, John, Robertson, Sara, Sathyamoorthy, Madhankumar, Chiao, Franklin, Patel, Jasmine, Sharma, Aarti, Echeverry Marin, Piedad, Pérez-Pradilla, Carolina, Singh, Neeta, von Ungern-Sternberg, Britta S., Sommerfield, David, Bilen-Rosas, Guelay, Lewkowitz-Shpuntoff, Hilana, Castro, Pilar, Riveros Perez, N. Ricardo, de Graaff, Jurgen C., Vega, Eduardo, González, Alejandro, Ostermann, Paola, Rubin, Kasia, Lord, Charles (Ted), Lee, Angela, Heitmiller, Eugenie, Valairucha, Songyos, Dalal, Priti, Tran, Thanh, Ayad, Ihab, Rehman, Mohamed, Fernandez, Allison, Zamora, Lillian, Ravula, Niroop, Shaik, Sadiq, Garcia-Marcinkiewicz, Annery G., Lee, Lisa K., Haydar, Bishr, Fiadjoe, John E., Matava, Clyde T., Kovatsis, Pete G., Peyton, James, Stein, Mary L., Park, Raymond, Taicher, Brad M., and Templeton, Thomas W.

Published
2023
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7. Pediatric Airway Management in Coronavirus Disease 2019 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia’s Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society

Author

Matava, Clyde T, Kovatsis, Pete G, Lee, Jennifer K, Castro, Pilar, Denning, Simon, Yu, Julie, Park, Raymond, Lockman, Justin L, Von Ungern-Sternberg, Britta, Sabato, Stefano, Lee, Lisa K, Ayad, Ihab, Mireles, Sam, Lardner, David, Whyte, Simon, Szolnoki, Judit, Jagannathan, Narasimhan, Thompson, Nicole, Stein, Mary Lyn, Dalesio, Nicholas, Greenberg, Robert, McCloskey, John, Peyton, James, Evans, Faye, Haydar, Bishr, Reynolds, Paul, Chiao, Franklin, Taicher, Brad, Templeton, Thomas, Bhalla, Tarun, Raman, Vidya T, Garcia-Marcinkiewicz, Annery, Gálvez, Jorge, Tan, Jonathan, Rehman, Mohamed, Crockett, Christy, Olomu, Patrick, Szmuk, Peter, Glover, Chris, Matuszczak, Maria, Galvez, Ignacio, Hunyady, Agnes, Polaner, David, Gooden, Cheryl, Hsu, Grace, Gumaney, Harshad, Pérez-Pradilla, Caroline, Kiss, Edgar E, Theroux, Mary C, Lau, Jennifer, Asaf, Saeedah, Ingelmo, Pablo, Engelhardt, Thomas, Hervías, Mónica, Greenwood, Eric, Javia, Luv, Disma, Nicola, Yaster, Myron, and Fiadjoe, John E

Subjects
Patient Safety, Lung, Pediatric, Clinical Research, Good Health and Well Being, Adolescent, Airway Management, Anesthesia, Anesthesiology, COVID-19, Child, Child, Preschool, Consensus, Coronavirus Infections, Guidelines as Topic, Humans, Infant, Infant, Newborn, Infection Control, Infectious Disease Transmission, Patient-to-Professional, Intubation, Intratracheal, Pandemics, Pediatrics, Pneumonia, Viral, PeDI-Collaborative, Clinical Sciences, Neurosciences
Abstract

The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.

Published
2020

8. Pediatric Airway Management in COVID-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society.

Author

Matava, Clyde T, Kovatsis, Pete G, Lee, Jennifer K, Castro, Pilar, Denning, Simon, Yu, Julie, Park, Raymond, Lockman, Justin L, Von Ungern-Sternberg, Britta, Sabato, Stefano, Lee, Lisa K, Ayad, Ihab, Mireles, Sam, Lardner, David, Whyte, Simon, Szolnoki, Judit, Jagannathan, Narasimhan, Thompson, Nicole, Stein, Mary Lyn, Dalesio, Nicholas, Greenberg, Robert, McCloskey, John, Peyton, James, Evans, Faye, Haydar, Bishr, Reynolds, Paul, Chiao, Franklin, Taicher, Brad, Templeton, Thomas, Bhalla, Tarun, Raman, Vidya T, Garcia-Marcinkiewicz, Annery, Gálvez, Jorge, Tan, Jonathan, Rehman, Mohamed, Crockett, Christy, Olomu, Patrick, Szmuk, Peter, Glover, Chris, Matuszczak, Maria, Galvez, Ignacio, Hunyady, Agnes, Polaner, David, Gooden, Cheryl, Hsu, Grace, Gumaney, Harshad, Pérez-Pradilla, Caroline, Kiss, Edgar E, Theroux, Mary C, Lau, Jennifer, Asaf, Saeedah, Ingelmo, Pablo, Engelhardt, Thomas, Hervías, Mónica, Greenwood, Eric, Javia, Luv, Disma, Nicola, Yaster, Myron, Fiadjoe, John E, and PeDI-Collaborative

Subjects
PeDI-Collaborative, Humans, Pneumonia, Viral, Coronavirus Infections, Anesthesia, Intubation, Intratracheal, Consensus, Anesthesiology, Pediatrics, Infection Control, Adolescent, Child, Child, Preschool, Infant, Infant, Newborn, Guidelines as Topic, Infectious Disease Transmission, Patient-to-Professional, Airway Management, Pandemics, Pneumonia, Viral, Intubation, Intratracheal, Preschool, Newborn, Infectious Disease Transmission, Patient-to-Professional, Clinical Sciences, Neurosciences
Abstract

The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.

Published
2020

12. Airway management in the paediatric difficult intubation registry: a propensity score matched analysis of outcomes over time

Author

Stein, Mary Lyn, primary, Sarmiento Argüello, Lina Andrea, additional, Staffa, Steven J., additional, Heunis, Julia, additional, Egbuta, Chinyere, additional, Flynn, Stephen G., additional, Khan, Sabina A., additional, Sabato, Stefano, additional, Taicher, Brad M., additional, Chiao, Franklin, additional, Bosenberg, Adrian, additional, Lee, Angela C., additional, Adams, H. Daniel, additional, von Ungern-Sternberg, Britta S., additional, Park, Raymond S., additional, Peyton, James M., additional, Olomu, Patrick N., additional, Hunyady, Agnes I., additional, Garcia-Marcinkiewicz, Annery, additional, Fiadjoe, John E., additional, Kovatsis, Pete G., additional, Bruins, Benjamin, additional, Stricker, Paul, additional, Laverriere, Elizabeth, additional, Lockman, Justin L., additional, Struyk, Brian, additional, Ward, Christopher, additional, Nishisaki, Akira, additional, Kodavatiganti, Ramesh, additional, Guris, Rodrigo Daly, additional, Sequera-Ramos, Luis, additional, Teen, Mark, additional, Oke, Ayodele, additional, Hsu, Grace, additional, Lingappan, Arul, additional, Battles, Rhae, additional, Bocanegra, Ashley, additional, Goldfarb, Tally, additional, Kiss, Edgar, additional, Szmuk, Peter, additional, Mireles, Sam, additional, Murray, Andrea, additional, Whyte, Simon, additional, Jain, Ranu, additional, Matuszczak, Maria, additional, Holmes, Christopher, additional, McCann, Alexander, additional, Matava, Clyde, additional, Dalesio, Nicholas, additional, Greenberg, Robert, additional, Lucero, Angela, additional, Desai, Sapna, additional, Rosander, Sondra, additional, Samba, Sindhu, additional, Schrock, Charles, additional, Nykiel-Bailey, Sydney, additional, Marsh, Jennifer, additional, Peterson, Melissa Brooks, additional, Lee, Amy, additional, Bhattacharya, Somaletha, additional, Burjek, Nicholas, additional, Jagannathan, Narasimhan, additional, Lardner, David, additional, Crockett, Christy, additional, Robetson, Sara, additional, Patel, Jasmine, additional, Sharma, Aarti, additional, Templeton, Thomas, additional, Marín, Piedad Echeverry, additional, Pérez-Pradilla, Carolina, additional, Singh, Neeta, additional, Sommerfield, David, additional, Hauser, Neil, additional, Hesselink, Emily, additional, Lewkowitz-Shpuntoff, Hilana, additional, Castro, Pilar, additional, Riveros Perez, N. Ricardo, additional, Vega, Eduardo, additional, González, Alejandro, additional, Ostermann, Paola, additional, Rubin, Kasia, additional, Meserve, Jonathan, additional, Lord, Charles, additional, Lee, Angela, additional, Valairucha, Songyos, additional, Dalal, Priti, additional, Tran, Thanh, additional, Anspach, Taylor, additional, Lee, Lisa K., additional, Ayad, Ihab, additional, Rehman, Mohamed, additional, Fernandez, Allison, additional, Zamora, Lillian, additional, Ravula, Niroop, additional, Shaik, Sadiq, additional, Szolnoki, Judit, additional, Mathew, Preethy, additional, Yaddanapudi, Sandhya, additional, Sen, Indu, additional, Gupta, Aakriti, additional, Handlogten, Kathryn, additional, Sroka, J. Michael, additional, Quintão, Vinícius Caldeira, additional, Carlos, Ricardo Vieira, additional, and Leite, Fernanda, additional

Published
2024
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14. A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry

Author

Sommerfield, David, Holmes, Chris, Ravula, Niroop, Jette, Christine, Mireles, Sam, Matava, Clyde, Whyte, Simon, Vega, Eduardo, Yang, Lei, Echeverry-Marin, Piedad, Perez-Pradilla, Carolina, Starker, Elizabeth, Zieg, Jennifer, Szolnoki, Judit, Lee, Angela, Heitmiller, Eugenie, Rehman, Mohamed, Zamora, Lillian, Fernandez, Allison, Meserve, Jonathan, Bhattacharya, Solmaletha, Reynolds, Paul, Lewis, Ian, Haydar, Bishr, Therrian, Megan, Sarmiento, Linare, Richtsfeld, Martina, Belani, Kumar, Robertson, Sara, Sathyamoorthy, Kumar, Schrock, Charles, de Graaff, Jurgen, Soneru, Codruta, Singh, Neeta, Taicher, Brad, Castro, Pilar, Riveros Perez, N.R., Stricker, Paul, Lockman, Justin L., Galvez, Jorge, Isserman, Rebecca, Struyk, Brian, Ward, Christopher, Hsu, Grace, Nishisaki, Akira, Kodavatiganti, Ramesh, Ramos, Luis S., Scheu, Eric, Bruins, Benjamin, Goldfarb, Tally, Szmuk, Peter, Jain, Ranu, Matuszczak, Maria, Polaner, David, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Rosas, Guelay B., Lee, Lisa K., Iyah, Ihab, Dalesio, Nicholas, Greenberg, Rob, Peyton, James, Park, Raymond, Staffa, Steven J., Sabato, Stefano, Templeton, Thomas W., Stein, Mary Lyn, Garcia-Marcinkiewicz, Annery G., Kiss, Edgar, Fiadjoe, John Edem, von Ungern-Sternberg, Britta, Chiao, Franklin, Olomu, Patrick, Zurakowski, David, and Kovatsis, Pete G.

Published
2021
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16. Airway management in neonates and infants

Author

Disma, Nicola, primary, Asai, Takashi, additional, Cools, Evelien, additional, Cronin, Alexandria, additional, Engelhardt, Thomas, additional, Fiadjoe, John, additional, Fuchs, Alexander, additional, Garcia-Marcinkiewicz, Annery, additional, Habre, Walid, additional, Heath, Chloe, additional, Johansen, Mathias, additional, Kaufmann, Jost, additional, Kleine-Brueggeney, Maren, additional, Kovatsis, Pete G., additional, Kranke, Peter, additional, Lusardi, Andrea C., additional, Matava, Clyde, additional, Peyton, James, additional, Riva, Thomas, additional, Romero, Carolina S., additional, von Ungern-Sternberg, Britta, additional, Veyckemans, Francis, additional, and Afshari, Arash, additional

Published
2023
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17. Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines

Author

Disma, Nicola, primary, Asai, Takashi, additional, Cools, Evelien, additional, Cronin, Alexandria, additional, Engelhardt, Thomas, additional, Fiadjoe, John, additional, Fuchs, Alexander, additional, Garcia-Marcinkiewicz, Annery, additional, Habre, Walid, additional, Heath, Chloe, additional, Johansen, Mathias, additional, Kaufmann, Jost, additional, Kleine-Brueggeney, Maren, additional, Kovatsis, Pete G., additional, Kranke, Peter, additional, Lusardi, Andrea C., additional, Matava, Clyde, additional, Peyton, James, additional, Riva, Thomas, additional, Romero, Carolina S., additional, von Ungern-Sternberg, Britta, additional, Veyckemans, Francis, additional, Afshari, Arash, additional, Srinivasan, Ilavajady, additional, Correia, Michelle, additional, Nghiem, Jessica, additional, Chowdhury, Apala R., additional, Marchesini, Vanessa, additional, Bonfiglio, Rachele, additional, and Bastianello, Matilde, additional

Published
2023
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19. Difficult intubation in syndromic versus nonsyndromic forms of micrognathia in children.

Author

Hunyady, Agnes I., Sergeeva, Vera, Kovatsis, Pete G., Evans, Kelly N., Staffa, Steven J., Zurakowski, David, Fiadjoe, John E., Jimenez, Nathalia, von Ungern‐Sternberg, Britta S, Sommerfield, David, Hauser, Neil, Taicher, Brad M, Dalesio, Nicholas M, Matuszczak, Maria, Garcia‐Marcinkiewicz, Annery G., Bruins, Benjamin B., Kodavatiganti, Ramesh, Hsu, Grace, Ward, Christopher, and Struyk, Brian

Subjects
TRACHEA intubation, MICROGNATHIA, INTUBATION, PROPENSITY score matching, CRANIOFACIAL abnormalities
Abstract

Background: We investigated how syndromic versus nonsyndromic forms of micrognathia impacted difficult intubation outcomes in children. Primary outcome was the first‐attempt success rate of tracheal intubation, secondary outcomes were number of intubation attempts and complications. We hypothesized that syndromic micrognathia would be associated with lower first‐attempt success rate. Methods: In micrognathic patients enrolled in the Pediatric Difficult Intubation Registry (08/2012–03/2019) we retrospectively compared demographic and clinical characteristics between children with nonsyndromic and syndromic micrognathia using standardized mean differences (SMD) and assessed the association of the presence of syndrome with the primary and secondary outcomes using propensity score matching analysis with and without matching for airway assessment findings. Results: Nonsyndromic patients (628) were less likely to have additional airway abnormalities. Syndromic patients (216) were less likely to have unanticipated difficult intubation (2% vs. 20%, SMD 0.59). First‐attempt success rates of intubation were: 38% in the syndromic versus 34% in the nonsyndromic group (odds ratio [OR] 1.18; 95% confidence intervals [95% CI] 0.74, 1.89; p =.478), and 37% versus 37% (OR 0.99; 95% CI 0.66, 1.48; p =.959). Median number of intubation attempts were 2 (interquartile range [IQR]: 1, 3; range: 1, 8) versus 2 (IQR: 1, 3; range 1, 12) (median regression coefficient = 0; 95% CI: −0.7, 0.7; p =.999) and 2 (IQR: 1, 3; range: 1, 12) versus 2 (IQR: 1, 3; range 1, 8) (median regression coefficient = 0; 95% CI: −0.5, 0.5; p =.999). Complication rates were 14% versus 22% (OR 0.6; 95% CI 0.34, 1.04; p =.07) and 16% versus 21% (OR 0.71; 95% CI 0.43, 1.17; p =.185). Conclusions: Presence of syndrome was not associated with lower first‐attempt success rate on intubation, number of intubation attempts, or complication rate among micrognathic patients difficult to intubate, despite more associated craniofacial abnormalities. Nonsyndromic patients were more likely to have unanticipated difficult intubations, first attempt with direct laryngoscopy. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Immediate extubation after pediatric liver transplantation: Update on a single‐center experience.

Author

Scalise, P. Nina, Koo, Donna C., Staffa, Steven J., Cuenca, Alex G., Kovatsis, Pete G., Kim, Heung Bae, and Lee, Eliza J.

Subjects
EXTUBATION, LIVER transplantation, LENGTH of stay in hospitals, LUNG transplantation
Abstract

Purpose: Immediate extubation (IE) following liver transplantation (LT) is increasingly common in adult patients. This study reviews our center's experience with IE in children following LT to determine characteristics predictive of successful IE and its effects on post‐operative outcomes. Methods: We performed a retrospective chart review of all patients who underwent LT at our institution between January 2005 and November 2022. Patients with concomitant lung transplants and chronic ventilator requirements were excluded. Results: Overall, 235 patients met study criteria. IE was achieved in 164 (69.8%) patients across all diagnoses and graft types. Of IE patients, only two required re‐intubation within 3 days post‐transplant. IE patients exhibited significantly shorter ICU (2 [1, 3 IQR] vs. 4 [2, 4 IQR] days, p <.001) and hospital lengths of stay (17 [12, 24 IQR] vs. 22 [14, 42 IQR] days, p =.001). Pre‐transplant ICU requirement, high PELD/MELD score, intraoperative transfusion, cold ischemia time, and pressor requirements were risk factors against IE. There was no association between IE and recipient age or weight. The proportion of patients undergoing IE post‐transplant increased significantly over time from 2005 to 2022 (p <.001), underscoring the role of clinical experience and transplant team learning curve. Conclusion: Spanning 18 years and 235 patients, we report the largest cohort of children undergoing IE following LT. Our findings support that IE is safe across ages and clinical scenarios. As our center gained experience, the rate of IE increased from 40% to 83%. These trends were associated with lower ICU and LOS, the benefits of which include earlier patient mobility and improved resource utilization. [ABSTRACT FROM AUTHOR]

Published
2024
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26. Difficult or impossible facemask ventilation in children with difficult tracheal intubation:a retrospective analysis of the PeDI registry

Author

Garcia-Marcinkiewicz, Annery G., Lee, Lisa K., Haydar, Bishr, Fiadjoe, John E., Matava, Clyde T., Kovatsis, Pete G., Peyton, James, Stein, Mary L., Park, Raymond, Taicher, Brad M., Templeton, Thomas W., Bruins, Benjamin B., Stricker, Paul, Laverriere, Elizabeth K., Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Daly Guris, Rodrigo J., Sequera-Ramos, Luis, Teen, Mark S., Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Goldfarb, Tally, Kiss, Edgar E., Olomu, Patrick N., Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Holmes, Christopher, Sabato, Stefan, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Reynolds, Paul, Lewis, Ian, Schrock, Charles, de Graaff, Jurgen C., Garcia-Marcinkiewicz, Annery G., Lee, Lisa K., Haydar, Bishr, Fiadjoe, John E., Matava, Clyde T., Kovatsis, Pete G., Peyton, James, Stein, Mary L., Park, Raymond, Taicher, Brad M., Templeton, Thomas W., Bruins, Benjamin B., Stricker, Paul, Laverriere, Elizabeth K., Lockman, Justin L., Struyk, Brian, Ward, Christopher, Nishisaki, Akira, Kodavatiganti, Ramesh, Daly Guris, Rodrigo J., Sequera-Ramos, Luis, Teen, Mark S., Oke, Ayodele, Hsu, Grace, Lingappan, Arul, Egbuta, Chinyere, Flynn, Stephen, Sarmiento, Lina, Goldfarb, Tally, Kiss, Edgar E., Olomu, Patrick N., Szmuk, Peter, Mireles, Sam, Murray, Andrea, Whyte, Simon, Jain, Ranu, Matuszczak, Maria, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Holmes, Christopher, Sabato, Stefan, Dalesio, Nicholas, Greenberg, Robert, Lucero, Angela, Reynolds, Paul, Lewis, Ian, Schrock, Charles, and de Graaff, Jurgen C.

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Published
2023

28. Airway management in neonates and infants

Author

Disma, Nicola, Asai, Takashi, Cools, Evelien, Cronin, Alexandria, Engelhardt, Thomas, Fiadjoe, John, Fuchs, Alexander, Garcia-Marcinkiewicz, Annery, Habre, Walid, Heath, Chloe, Johansen, Mathias, Kaufmann, Jost, Kleine-Brueggeney, Maren, Kovatsis, Pete G., Kranke, Peter, Lusardi, Andrea C., Matava, Clyde, Peyton, James, Riva, Thomas, Romero, Carolina S., von Ungern-Sternberg, Britta, Veyckemans, Francis, and Afshari, Arash

Published
2024
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30. Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry

Author

Burjek, Nicholas E., Nishisaki, Akira, Fiadjoe, John E., Adams, H. Daniel, Peeples, Kenneth N., Raman, Vidya T., Olomu, Patrick N., Kovatsis, Pete G., Jagannathan, Narasimhan, Hunyady, Agnes, Bosenberg, Adrian, Tham, See, Low, Daniel, Hopkins, Paul, Glover, Chris, Olutoye, Olutoyin, Szmuk, Peter, McCloskey, John, Dalesio, Nicholas, Koka, Rahul, Greenberg, Robert, Watkins, Scott, Patel, Vikram, Reynolds, Paul, Matuszczak, Maria, Jain, Ranu, Khalil, Samia, Polaner, David, Zieg, Jennifer, Szolnoki, Judit, Sathyamoorthy, Kumar, Taicher, Brad, Riveros Perez, N. Ricardo, Bhattacharya, Solmaletha, Bhalla, Tarun, Stricker, Paul, Lockman, Justin, Galvez, Jorge, Rehman, Mohamed, Von Ungern-Sternberg, Britta, Sommerfield, David, Soneru, Codruta, Chiao, Franklin, Richtsfeld, Martina, Belani, Kumar, Sarmiento, Lina, Mireles, Sam, Bilen Rosas, Guelay, Park, Raymond, and Peyton, James

Published
2017
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37. Lessons from COVID‐19: A reflection on the strengths and weakness of early consensus recommendations for pediatric difficult airway management during a respiratory viral pandemic using a modified Delphi method

Author

Stein, Mary Lyn, primary, Park, Raymond S., additional, Afshari, Arash, additional, Disma, Nicola, additional, Fiadjoe, John E., additional, Matava, Clyde T., additional, McNarry, Alistair F., additional, Ungern‐Sternberg, Britta S., additional, Kovatsis, Pete G., additional, and Peyton, James M., additional

Published
2021
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41. Lessons from COVID-19:A reflection on the strengths and weakness of early consensus recommendations for pediatric difficult airway management during a respiratory viral pandemic using a modified Delphi method

Author

Stein, Mary Lyn, Park, Raymond S., Afshari, Arash, Disma, Nicola, Fiadjoe, John E., Matava, Clyde T., McNarry, Alistair F., von Ungern-Sternberg, Britta S., Kovatsis, Pete G., Peyton, James M., Stein, Mary Lyn, Park, Raymond S., Afshari, Arash, Disma, Nicola, Fiadjoe, John E., Matava, Clyde T., McNarry, Alistair F., von Ungern-Sternberg, Britta S., Kovatsis, Pete G., and Peyton, James M.

Abstract

Background: The authors recognized a gap in existing guidelines and convened a modified Delphi process to address novel issues in pediatric difficult airway management raised by the COVID-19 pandemic. Methods: The Pediatric Difficult Intubation Collaborative, a working group of the Society for Pediatric Anesthesia, assembled an international panel to reach consensus recommendations on pediatric difficult airway management during the COVID-19 pandemic using a modified Delphi method. We reflect on the strengths and weaknesses of this process and ways care has changed as knowledge and experience have grown over the course of the pandemic. Recommendations: In the setting of the COVID-19 pandemic, the Delphi panel recommends against moving away from the operating room solely for the purpose of having a negative pressure environment. The Delphi panel recommends supplying supplemental oxygen and using videolaryngoscopy during anticipated difficult airway management. Direct laryngoscopy is not recommended. If the patient meets extubation criteria, extubate in the OR, awake, at the end of the procedure. Reflection: These recommendations remain valuable guidance in caring for children with anticipated difficult airways and infectious respiratory pathology when reviewed in light of our growing knowledge and experience with COVID-19. The panel initially recommended minimizing involvement of additional people and trainees and minimizing techniques associated with aerosolization of viral particles. The demonstrated effectiveness of PPE and vaccination at reducing the risk of exposure and infection to clinicians managing the airway makes these recommendations less relevant for COVID-19. They would likely be important initial steps in the face of novel respiratory viral pathogens. Conclusions: The consensus process cannot and should not replace evidence-based guidelines; however, it is encouraging to see that the panel's recommendations have held up well as scientific knowledge

Published
2021

46. A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry

Author

Peyton, James, primary, Park, Raymond, additional, Staffa, Steven J., additional, Sabato, Stefano, additional, Templeton, Thomas W., additional, Stein, Mary Lyn, additional, Garcia-Marcinkiewicz, Annery G., additional, Kiss, Edgar, additional, Fiadjoe, John Edem, additional, von Ungern-Sternberg, Britta, additional, Chiao, Franklin, additional, Olomu, Patrick, additional, Zurakowski, David, additional, Kovatsis, Pete G., additional, Sommerfield, David, additional, Holmes, Chris, additional, Ravula, Niroop, additional, Jette, Christine, additional, Mireles, Sam, additional, Matava, Clyde, additional, Whyte, Simon, additional, Vega, Eduardo, additional, Yang, Lei, additional, Echeverry-Marin, Piedad, additional, Perez-Pradilla, Carolina, additional, Starker, Elizabeth, additional, Zieg, Jennifer, additional, Szolnoki, Judit, additional, Lee, Angela, additional, Heitmiller, Eugenie, additional, Rehman, Mohamed, additional, Zamora, Lillian, additional, Fernandez, Allison, additional, Meserve, Jonathan, additional, Bhattacharya, Solmaletha, additional, Reynolds, Paul, additional, Lewis, Ian, additional, Haydar, Bishr, additional, Therrian, Megan, additional, Sarmiento, Linare, additional, Richtsfeld, Martina, additional, Belani, Kumar, additional, Robertson, Sara, additional, Sathyamoorthy, Kumar, additional, Schrock, Charles, additional, de Graaff, Jurgen, additional, Soneru, Codruta, additional, Singh, Neeta, additional, Taicher, Brad, additional, Castro, Pilar, additional, Riveros Perez, N.R., additional, Stricker, Paul, additional, Lockman, Justin L., additional, Galvez, Jorge, additional, Isserman, Rebecca, additional, Struyk, Brian, additional, Ward, Christopher, additional, Hsu, Grace, additional, Nishisaki, Akira, additional, Kodavatiganti, Ramesh, additional, Ramos, Luis S., additional, Scheu, Eric, additional, Bruins, Benjamin, additional, Goldfarb, Tally, additional, Szmuk, Peter, additional, Jain, Ranu, additional, Matuszczak, Maria, additional, Polaner, David, additional, Hunyady, Agnes, additional, Bosenberg, Adrian, additional, Tham, See, additional, Low, Daniel, additional, Rosas, Guelay B., additional, Lee, Lisa K., additional, Iyah, Ihab, additional, Dalesio, Nicholas, additional, and Greenberg, Rob, additional

Published
2021
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47. First-attempt success rate of video laryngoscopy in small infants (VISI): a multicentre, randomised controlled trial

Author

Garcia-Marcinkiewicz, Annery G, primary, Kovatsis, Pete G, additional, Hunyady, Agnes I, additional, Olomu, Patrick N, additional, Zhang, Bingqing, additional, Sathyamoorthy, Madhankumar, additional, Gonzalez, Adolfo, additional, Kanmanthreddy, Siri, additional, Gálvez, Jorge A, additional, Franz, Amber M, additional, Peyton, James, additional, Park, Raymond, additional, Kiss, Edgar E, additional, Sommerfield, David, additional, Griffis, Heather, additional, Nishisaki, Akira, additional, von Ungern-Sternberg, Britta S, additional, Nadkarni, Vinay M, additional, McGowan, Francis X, additional, Fiadjoe, John E, additional, Ladner, David, additional, Burjek, Nicholas, additional, Jagannathan, Narasimhan, additional, Hadjuk, John, additional, Asaf, Saeedah, additional, Glover, Chris, additional, Stein, Mary L, additional, Kodavatiganti, Ramesh, additional, Bruins, B B, additional, Struyk, Brian, additional, Sequera-Ramos, Luis, additional, Ward, Christopher, additional, Laverriere, Elizabeth, additional, Gurnaney, Harshad, additional, Scheu, Eric, additional, Farrell, Heather, additional, Stricker, Paul, additional, Castro, Pilar, additional, Lee, Angela, additional, Valairucha, Songyos, additional, Szolnoki, Judit, additional, Zieg, Jennifer, additional, Chiao, Franklin B, additional, Taicher, Brad M, additional, De Graaff, Jurgen C, additional, Dalesio, Nicholas M, additional, Greenberg, Robert S, additional, Lucero, Angela R, additional, Zamora, Lillian, additional, Fernandez, Allison, additional, Mohamed, Nada, additional, Sabato, Stefano C, additional, Holmes, Christopher D, additional, Bhattacharya, Somaletha T, additional, Meserve, Jonathan, additional, Reynolds, Paul I, additional, Haydar, Bishr, additional, Weber, Monica, additional, Therrian, Megan, additional, Richtsfeld, Martina, additional, and Teen, Mark S, additional

Published
2020
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