Incidence of difficult bag‐mask ventilation in children: a prospective observational study

Abstract

This is the first published report of the incidence of unexpected DBMV among healthy pediatric patients.

Evaluation of emergency pediatric tracheal intubation by pediatric anesthesiologists on inpatient units and the emergency department

“…Multiple studies of emergency tracheal intubation in adults performed by anesthesiologists outside the OR have demonstrated a higher incidence of difficult intubation compared to elective intubation in the OR . Similarly our observed difficult intubation rate of 10.6% and multiple laryngoscopy attempts associated with pediatric emergency tracheal intubation on inpatient locations and ED are substantially higher than that reported in the general pediatric population in the intraoperative setting . Studies of pediatric emergency tracheal intubation performed by intensivists and ED physicians have also reported a high incidence of difficult intubation or multiple laryngoscopy attempts (i.e., 8.8%, 7–22%) .…”

“…Respiratory distress or failure was the foremost indication for intubation, followed by cardiopulmonary arrest. Twenty‐four percent of the emergency tracheal intubation occurred in children with diagnoses of craniofacial abnormality and 30% intubations were observed in children with at least one anatomical feature known to be associated with difficult laryngoscopy and intubation in controlled OR settings . A majority of emergency tracheal intubations involved use of an intravenous anesthetic induction agent and/or a sedative (27 [20.5%] propofol, 19 [14.4%] etomidate, 17 [12.9%], ketamine, and 36 [27.3%] a benzodiazepine), while a neuromuscular blockade agent was administered in more than half of emergency tracheal intubations including 54 (40.9%) with succinylcholine and 21 (16%) a nondepolarizing agent.…”

Development of a guideline for the management of the unanticipated difficult airway in pediatric practice

“…The interventions used to achieve effective bag MV, and the order in which they should be used, have little published evidence base, although the incidence of unexpected difficult bag MV in children may be as high as 6% (Figure ). The Delphi process allowed each step to be considered not only just for efficacy but also to explore the order in which the individual adjustment would most usefully be made.…”

Description and function of a difficult airway service

“…Difficult airway management occurs less frequently in pediatric patients than adults with fewer children (6%) required additional management techniques to be adequately ventilated with bag‐mask and less than 2% that are considered difficult to intubate . However, when airway management problems are encountered in children, morbidity and mortality related to these airway complications are more common than when compared to adults .…”