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

An Analysis from the Multicenter Pediatric Difficult Intubation Registry

Nicholas E. Burjek, Akira Nishisaki, John E. Fiadjoe, H. Daniel Adams, Kenneth N. Peeples, Vidya T. Raman, Patrick N. Olomu, Pete G. Kovatsis, Narasimhan Jagannathan*, Agnes Hunyady, Adrian Bosenberg, See Tham, Daniel Low, Paul Hopkins, Chris Glover, Olutoyin Olutoye, Peter Szmuk, John McCloskey, Nicholas Dalesio, Rahul Koka & 31 others Robert Greenberg, Scott Watkins, Vikram Patel, Paul Reynolds, Maria Matuszczak, Ranu Jain, Samia Khalil, David Polaner, Jennifer Zieg, Judit Szolnoki, Kumar Sathyamoorthy, Brad Taicher, N. Ricardo Riveros Perez, Solmaletha Bhattacharya, Tarun Bhalla, Paul Stricker, Justin Lockman, Jorge Galvez, Mohamed Rehman, Britta Von Ungern-Sternberg, David Sommerfield, Codruta Soneru, Franklin Chiao, Martina Richtsfeld, Kumar Belani, Lina Sarmiento, Sam Mireles, Guelay Bilen Rosas, Raymond Park, James Peyton, PeDI Collaborative Investigators

*Corresponding author for this work

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)432-440
Number of pages9
JournalAnesthesiology
Volume127
Issue number3
DOIs
StatePublished - Sep 1 2017

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Intubation
Registries
Pediatrics
Ventilation
Odds Ratio
Incidence

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

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 ; Perez, N. Ricardo Riveros ; 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 ; Rosas, Guelay Bilen ; Park, Raymond ; Peyton, James ; PeDI Collaborative Investigators. / Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway : An Analysis from the Multicenter Pediatric Difficult Intubation Registry. In: Anesthesiology. 2017 ; Vol. 127, No. 3. pp. 432-440.
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title = "Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry",
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.",
author = "Burjek, {Nicholas E.} and Akira Nishisaki and Fiadjoe, {John E.} and Adams, {H. Daniel} and Peeples, {Kenneth N.} and Raman, {Vidya T.} and Olomu, {Patrick N.} and Kovatsis, {Pete G.} and Narasimhan Jagannathan and Agnes Hunyady and Adrian Bosenberg and See Tham and Daniel Low and Paul Hopkins and Chris Glover and Olutoyin Olutoye and Peter Szmuk and John McCloskey and Nicholas Dalesio and Rahul Koka and Robert Greenberg and Scott Watkins and Vikram Patel and Paul Reynolds and Maria Matuszczak and Ranu Jain and Samia Khalil and David Polaner and Jennifer Zieg and Judit Szolnoki and Kumar Sathyamoorthy and Brad Taicher and Perez, {N. Ricardo Riveros} and Solmaletha Bhattacharya and Tarun Bhalla and Paul Stricker and Justin Lockman and Jorge Galvez and Mohamed Rehman and {Von Ungern-Sternberg}, Britta and David Sommerfield and Codruta Soneru and Franklin Chiao and Martina Richtsfeld and Kumar Belani and Lina Sarmiento and Sam Mireles and Rosas, {Guelay Bilen} and Raymond Park and James Peyton and {PeDI Collaborative Investigators}",
year = "2017",
month = "9",
day = "1",
doi = "10.1097/ALN.0000000000001758",
language = "English (US)",
volume = "127",
pages = "432--440",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "3",

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Burjek, NE, Nishisaki, A, Fiadjoe, JE, Adams, HD, Peeples, KN, Raman, VT, Olomu, PN, Kovatsis, PG, Jagannathan, N, Hunyady, A, Bosenberg, A, Tham, S, Low, D, Hopkins, P, Glover, C, Olutoye, O, Szmuk, P, McCloskey, J, Dalesio, N, Koka, R, Greenberg, R, Watkins, S, Patel, V, Reynolds, P, Matuszczak, M, Jain, R, Khalil, S, Polaner, D, Zieg, J, Szolnoki, J, Sathyamoorthy, K, Taicher, B, Perez, NRR, Bhattacharya, S, Bhalla, T, Stricker, P, Lockman, J, Galvez, J, Rehman, M, Von Ungern-Sternberg, B, Sommerfield, D, Soneru, C, Chiao, F, Richtsfeld, M, Belani, K, Sarmiento, L, Mireles, S, Rosas, GB, Park, R, Peyton, J & PeDI Collaborative Investigators 2017, 'Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway: An Analysis from the Multicenter Pediatric Difficult Intubation Registry', Anesthesiology, vol. 127, no. 3, pp. 432-440. https://doi.org/10.1097/ALN.0000000000001758

Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway : An Analysis from the Multicenter Pediatric Difficult Intubation Registry. / 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; Perez, N. Ricardo Riveros; 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; Rosas, Guelay Bilen; Park, Raymond; Peyton, James; PeDI Collaborative Investigators.

In: Anesthesiology, Vol. 127, No. 3, 01.09.2017, p. 432-440.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Videolaryngoscopy versus Fiber-optic Intubation through a Supraglottic Airway in Children with a Difficult Airway

T2 - An Analysis from the Multicenter Pediatric Difficult Intubation Registry

AU - Burjek, Nicholas E.

AU - Nishisaki, Akira

AU - Fiadjoe, John E.

AU - Adams, H. Daniel

AU - Peeples, Kenneth N.

AU - Raman, Vidya T.

AU - Olomu, Patrick N.

AU - Kovatsis, Pete G.

AU - Jagannathan, Narasimhan

AU - Hunyady, Agnes

AU - Bosenberg, Adrian

AU - Tham, See

AU - Low, Daniel

AU - Hopkins, Paul

AU - Glover, Chris

AU - Olutoye, Olutoyin

AU - Szmuk, Peter

AU - McCloskey, John

AU - Dalesio, Nicholas

AU - Koka, Rahul

AU - Greenberg, Robert

AU - Watkins, Scott

AU - Patel, Vikram

AU - Reynolds, Paul

AU - Matuszczak, Maria

AU - Jain, Ranu

AU - Khalil, Samia

AU - Polaner, David

AU - Zieg, Jennifer

AU - Szolnoki, Judit

AU - Sathyamoorthy, Kumar

AU - Taicher, Brad

AU - Perez, N. Ricardo Riveros

AU - Bhattacharya, Solmaletha

AU - Bhalla, Tarun

AU - Stricker, Paul

AU - Lockman, Justin

AU - Galvez, Jorge

AU - Rehman, Mohamed

AU - Von Ungern-Sternberg, Britta

AU - Sommerfield, David

AU - Soneru, Codruta

AU - Chiao, Franklin

AU - Richtsfeld, Martina

AU - Belani, Kumar

AU - Sarmiento, Lina

AU - Mireles, Sam

AU - Rosas, Guelay Bilen

AU - Park, Raymond

AU - Peyton, James

AU - PeDI Collaborative Investigators

PY - 2017/9/1

Y1 - 2017/9/1

N2 - 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.

AB - 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.

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UR - http://www.scopus.com/inward/citedby.url?scp=85021259541&partnerID=8YFLogxK

U2 - 10.1097/ALN.0000000000001758

DO - 10.1097/ALN.0000000000001758

M3 - Article

VL - 127

SP - 432

EP - 440

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 3

ER -