Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry

A prospective cohort analysis

John Edem Fiadjoe*, Akira Nishisaki, Narasimhan Jagannathan, Agnes I. Hunyady, Robert S. Greenberg, Paul I. Reynolds, Maria E. Matuszczak, Mohamed A. Rehman, David M. Polaner, Peter Szmuk, Vinay M. Nadkarni, Francis X. McGowan, Ronald S. Litman, Pete G. Kovatsis

*Corresponding author for this work

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Background: Despite the established vulnerability of children during airway management, remarkably little is known about complications in children with difficult tracheal intubation. To address this concern, we developed a multicentre registry (Pediatric Difficult Intubation [PeDI]) to characterise risk factors for difficult tracheal intubation, establish the success rates of various tracheal intubation techniques, catalogue the complications of children with difficult tracheal intubation, and establish the effect of more than two tracheal intubation attempts on complications. Methods: The PeDI registry consists of prospectively collected tracheal intubation data from 13 children's hospitals in the USA. We established standard data collection methods before implementing the secure web-based registry. After establishing standard definitions, we collected and analysed patient, clinician, and practice data and tracheal intubation outcomes. We categorised complications as severe or non-severe. Findings: Between August, 2012, and January, 2015, 1018 difficult paediatric tracheal intubation encounters were done. The most frequently attempted first tracheal intubation techniques were direct laryngoscopy (n=461, 46%), fibre-optic bronchoscopy (n=284 [28%]), and indirect video laryngoscopy (n=183 [18%]) with first attempt success rates of 16 (3%) of 461 with direct laryngoscopy, 153 (54%) of 284 with fibre-optic bronchoscopy, and 101 (55%) of 183 with indirect video laryngoscopy. Tracheal intubation failed in 19 (2%) of cases. 204 (20%) children had at least one complication; 30 (3%) of these were severe and 192 (19%) were non-severe. The most common severe complication was cardiac arrest, which occurred in 15 (2%) patients. The occurrence of complications was associated with more than two tracheal intubation attempts, a weight of less than 10 kg, short thyromental distance, and three direct laryngoscopy attempts before an indirect technique. Temporary hypoxaemia was the most frequent non-severe complication. Interpretation: More than two direct laryngoscopy attempts in children with difficult tracheal intubation are associated with a high failure rate and an increased incidence of severe complications. These results suggest that limiting the number of direct laryngoscopy attempts and quickly transitioning to an indirect technique when direct laryngoscopy fails would enhance patient safety. Funding: None.

Original languageEnglish (US)
Pages (from-to)37-48
Number of pages12
JournalThe Lancet Respiratory Medicine
Volume4
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Airway Management
Intubation
Registries
Cohort Studies
Laryngoscopy
Pediatrics
Bronchoscopy
Patient Safety
Heart Arrest

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Fiadjoe, John Edem ; Nishisaki, Akira ; Jagannathan, Narasimhan ; Hunyady, Agnes I. ; Greenberg, Robert S. ; Reynolds, Paul I. ; Matuszczak, Maria E. ; Rehman, Mohamed A. ; Polaner, David M. ; Szmuk, Peter ; Nadkarni, Vinay M. ; McGowan, Francis X. ; Litman, Ronald S. ; Kovatsis, Pete G. / Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry : A prospective cohort analysis. In: The Lancet Respiratory Medicine. 2016 ; Vol. 4, No. 1. pp. 37-48.
@article{ac969adf18bd475bafcda16dc3cd5906,
title = "Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: A prospective cohort analysis",
abstract = "Background: Despite the established vulnerability of children during airway management, remarkably little is known about complications in children with difficult tracheal intubation. To address this concern, we developed a multicentre registry (Pediatric Difficult Intubation [PeDI]) to characterise risk factors for difficult tracheal intubation, establish the success rates of various tracheal intubation techniques, catalogue the complications of children with difficult tracheal intubation, and establish the effect of more than two tracheal intubation attempts on complications. Methods: The PeDI registry consists of prospectively collected tracheal intubation data from 13 children's hospitals in the USA. We established standard data collection methods before implementing the secure web-based registry. After establishing standard definitions, we collected and analysed patient, clinician, and practice data and tracheal intubation outcomes. We categorised complications as severe or non-severe. Findings: Between August, 2012, and January, 2015, 1018 difficult paediatric tracheal intubation encounters were done. The most frequently attempted first tracheal intubation techniques were direct laryngoscopy (n=461, 46{\%}), fibre-optic bronchoscopy (n=284 [28{\%}]), and indirect video laryngoscopy (n=183 [18{\%}]) with first attempt success rates of 16 (3{\%}) of 461 with direct laryngoscopy, 153 (54{\%}) of 284 with fibre-optic bronchoscopy, and 101 (55{\%}) of 183 with indirect video laryngoscopy. Tracheal intubation failed in 19 (2{\%}) of cases. 204 (20{\%}) children had at least one complication; 30 (3{\%}) of these were severe and 192 (19{\%}) were non-severe. The most common severe complication was cardiac arrest, which occurred in 15 (2{\%}) patients. The occurrence of complications was associated with more than two tracheal intubation attempts, a weight of less than 10 kg, short thyromental distance, and three direct laryngoscopy attempts before an indirect technique. Temporary hypoxaemia was the most frequent non-severe complication. Interpretation: More than two direct laryngoscopy attempts in children with difficult tracheal intubation are associated with a high failure rate and an increased incidence of severe complications. These results suggest that limiting the number of direct laryngoscopy attempts and quickly transitioning to an indirect technique when direct laryngoscopy fails would enhance patient safety. Funding: None.",
author = "Fiadjoe, {John Edem} and Akira Nishisaki and Narasimhan Jagannathan and Hunyady, {Agnes I.} and Greenberg, {Robert S.} and Reynolds, {Paul I.} and Matuszczak, {Maria E.} and Rehman, {Mohamed A.} and Polaner, {David M.} and Peter Szmuk and Nadkarni, {Vinay M.} and McGowan, {Francis X.} and Litman, {Ronald S.} and Kovatsis, {Pete G.}",
year = "2016",
month = "1",
day = "1",
doi = "10.1016/S2213-2600(15)00508-1",
language = "English (US)",
volume = "4",
pages = "37--48",
journal = "The Lancet Respiratory Medicine",
issn = "2213-2600",
publisher = "Elsevier Limited",
number = "1",

}

Fiadjoe, JE, Nishisaki, A, Jagannathan, N, Hunyady, AI, Greenberg, RS, Reynolds, PI, Matuszczak, ME, Rehman, MA, Polaner, DM, Szmuk, P, Nadkarni, VM, McGowan, FX, Litman, RS & Kovatsis, PG 2016, 'Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: A prospective cohort analysis', The Lancet Respiratory Medicine, vol. 4, no. 1, pp. 37-48. https://doi.org/10.1016/S2213-2600(15)00508-1

Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry : A prospective cohort analysis. / Fiadjoe, John Edem; Nishisaki, Akira; Jagannathan, Narasimhan; Hunyady, Agnes I.; Greenberg, Robert S.; Reynolds, Paul I.; Matuszczak, Maria E.; Rehman, Mohamed A.; Polaner, David M.; Szmuk, Peter; Nadkarni, Vinay M.; McGowan, Francis X.; Litman, Ronald S.; Kovatsis, Pete G.

In: The Lancet Respiratory Medicine, Vol. 4, No. 1, 01.01.2016, p. 37-48.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry

T2 - A prospective cohort analysis

AU - Fiadjoe, John Edem

AU - Nishisaki, Akira

AU - Jagannathan, Narasimhan

AU - Hunyady, Agnes I.

AU - Greenberg, Robert S.

AU - Reynolds, Paul I.

AU - Matuszczak, Maria E.

AU - Rehman, Mohamed A.

AU - Polaner, David M.

AU - Szmuk, Peter

AU - Nadkarni, Vinay M.

AU - McGowan, Francis X.

AU - Litman, Ronald S.

AU - Kovatsis, Pete G.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Despite the established vulnerability of children during airway management, remarkably little is known about complications in children with difficult tracheal intubation. To address this concern, we developed a multicentre registry (Pediatric Difficult Intubation [PeDI]) to characterise risk factors for difficult tracheal intubation, establish the success rates of various tracheal intubation techniques, catalogue the complications of children with difficult tracheal intubation, and establish the effect of more than two tracheal intubation attempts on complications. Methods: The PeDI registry consists of prospectively collected tracheal intubation data from 13 children's hospitals in the USA. We established standard data collection methods before implementing the secure web-based registry. After establishing standard definitions, we collected and analysed patient, clinician, and practice data and tracheal intubation outcomes. We categorised complications as severe or non-severe. Findings: Between August, 2012, and January, 2015, 1018 difficult paediatric tracheal intubation encounters were done. The most frequently attempted first tracheal intubation techniques were direct laryngoscopy (n=461, 46%), fibre-optic bronchoscopy (n=284 [28%]), and indirect video laryngoscopy (n=183 [18%]) with first attempt success rates of 16 (3%) of 461 with direct laryngoscopy, 153 (54%) of 284 with fibre-optic bronchoscopy, and 101 (55%) of 183 with indirect video laryngoscopy. Tracheal intubation failed in 19 (2%) of cases. 204 (20%) children had at least one complication; 30 (3%) of these were severe and 192 (19%) were non-severe. The most common severe complication was cardiac arrest, which occurred in 15 (2%) patients. The occurrence of complications was associated with more than two tracheal intubation attempts, a weight of less than 10 kg, short thyromental distance, and three direct laryngoscopy attempts before an indirect technique. Temporary hypoxaemia was the most frequent non-severe complication. Interpretation: More than two direct laryngoscopy attempts in children with difficult tracheal intubation are associated with a high failure rate and an increased incidence of severe complications. These results suggest that limiting the number of direct laryngoscopy attempts and quickly transitioning to an indirect technique when direct laryngoscopy fails would enhance patient safety. Funding: None.

AB - Background: Despite the established vulnerability of children during airway management, remarkably little is known about complications in children with difficult tracheal intubation. To address this concern, we developed a multicentre registry (Pediatric Difficult Intubation [PeDI]) to characterise risk factors for difficult tracheal intubation, establish the success rates of various tracheal intubation techniques, catalogue the complications of children with difficult tracheal intubation, and establish the effect of more than two tracheal intubation attempts on complications. Methods: The PeDI registry consists of prospectively collected tracheal intubation data from 13 children's hospitals in the USA. We established standard data collection methods before implementing the secure web-based registry. After establishing standard definitions, we collected and analysed patient, clinician, and practice data and tracheal intubation outcomes. We categorised complications as severe or non-severe. Findings: Between August, 2012, and January, 2015, 1018 difficult paediatric tracheal intubation encounters were done. The most frequently attempted first tracheal intubation techniques were direct laryngoscopy (n=461, 46%), fibre-optic bronchoscopy (n=284 [28%]), and indirect video laryngoscopy (n=183 [18%]) with first attempt success rates of 16 (3%) of 461 with direct laryngoscopy, 153 (54%) of 284 with fibre-optic bronchoscopy, and 101 (55%) of 183 with indirect video laryngoscopy. Tracheal intubation failed in 19 (2%) of cases. 204 (20%) children had at least one complication; 30 (3%) of these were severe and 192 (19%) were non-severe. The most common severe complication was cardiac arrest, which occurred in 15 (2%) patients. The occurrence of complications was associated with more than two tracheal intubation attempts, a weight of less than 10 kg, short thyromental distance, and three direct laryngoscopy attempts before an indirect technique. Temporary hypoxaemia was the most frequent non-severe complication. Interpretation: More than two direct laryngoscopy attempts in children with difficult tracheal intubation are associated with a high failure rate and an increased incidence of severe complications. These results suggest that limiting the number of direct laryngoscopy attempts and quickly transitioning to an indirect technique when direct laryngoscopy fails would enhance patient safety. Funding: None.

UR - http://www.scopus.com/inward/record.url?scp=84952916618&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84952916618&partnerID=8YFLogxK

U2 - 10.1016/S2213-2600(15)00508-1

DO - 10.1016/S2213-2600(15)00508-1

M3 - Article

VL - 4

SP - 37

EP - 48

JO - The Lancet Respiratory Medicine

JF - The Lancet Respiratory Medicine

SN - 2213-2600

IS - 1

ER -