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 KokaRobert 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

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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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ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Burjek, N. E., Nishisaki, A., Fiadjoe, J. E., Adams, H. D., Peeples, K. N., Raman, V. T., Olomu, P. N., Kovatsis, P. G., Jagannathan, N., Hunyady, A., Bosenberg, A., Tham, S., Low, D., Hopkins, P., Glover, C., Olutoye, O., Szmuk, P., McCloskey, J., Dalesio, N., ... 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, 127(3), 432-440. https://doi.org/10.1097/ALN.0000000000001758