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Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway

Authors :
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
Mohamed A. Rehman
Source :
Anesthesiology. 127:432-440
Publication Year :
2017
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2017.

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.

Details

ISSN :
00033022
Volume :
127
Database :
OpenAIRE
Journal :
Anesthesiology
Accession number :
edsair.doi...........831144da8db8d0b51087d404feb94629