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

Bai, Wenyu; Golmirzaie, Kristine; Burke, Constance; Veen, Tara van; Christensen, Robert E.; Voepel‐Lewis, Terri; Malviya, Shobha

doi:10.1111/pan.12839

Cited by 20 publications

(15 citation statements)

References 27 publications

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“…Endotracheal intubation is a frequent procedure in pediatric emergency and surgery department. The intubation in children may be performed by staff in emergency department, intensive care unit, anesthesia and general pediatric staff [ 15 ]. Once the decision for intubation has been made, the choice should be between the cuffed or uncuffed endotracheal tubes [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Cuffed versus uncuffed endotracheal tubes in pediatrics: a meta-analysis

et al. 2018

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AbstractBackgroundCuffed and uncuffed endotracheal tubes are commonly used for pediatric patients in surgery and emergency situations. It is still controversial which approach should be adopted. The purpose of the study was to compare the application of cuffed and uncuffed endotracheal tubes in pediatric patients.MethodsWe searched PubMed, Web of Science and Cochrane Library for clinical trials, which compared the two applications in children. The study characteristics and clinical data were summarized by two independent reviewers. Meta-analysis of the data was done using Revman 5.3 software.Results6 studies with 4141 cases were included in this meta-analysis. The pooling analysis showed that more patients need tube changes in uncuffed than cuffed tubes (OR: 0.07, 95% CI: 0.05-0.10, P < 0.00001). However, there were no differences on intubation duration, reintubation occurrence, accidental extubation rate, croup occurrence and racemic epinephrine use during the intubation process. Also we didn’t find any differences on laryngospasm and stridor occurrence after extubation.ConclusionsOur study demonstrated that uncuffed endotracheal tubes increased the need for tube changes. Other incidences or complications between the two groups had no differences. Cuffed tubes may be an optimal option for pediatric patients. But more trials are needed in the future.

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Section: Discussionmentioning

confidence: 99%

Cuffed versus uncuffed endotracheal tubes in pediatrics: a meta-analysis

et al. 2018

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“…1-4 Although rare in general, patients at risk for critical airway events are common in pediatric academic hospitals, especially in centers with large referral bases and complex airway surgery programs. 4-7…”

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confidence: 99%

Critical Airway Team: A Retrospective Study of an Airway Response System in a Pediatric Hospital

Sterrett

Myer

Oehler

et al. 2017

Otolaryngol.--head neck surg.

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Objective Study the performance of a pediatric critical airway response team. Study Design Case series with chart review. Setting Freestanding academic children's hospital. Subjects and Methods A structured review of the electronic medical record was conducted for all activations of the critical airway team. Characteristics of the activations and patients are reported using descriptive statistics. Activation of the critical airway team occurred 196 times in 46 months (March 2012 to December 2015); complete data were available for 162 activations (83%). For 49 activations (30%), patients had diagnoses associated with difficult intubation; 45 (28%) had a history of difficult laryngoscopy. Results Activation occurred at least 4 times per month on average (vs 3 per month for hospital-wide codes). The most common reasons for team activation were anticipated difficult intubation (45%) or failed intubation attempt (20%). For 79% of activations, the team performed an airway procedure, most commonly direct laryngoscopy and tracheal intubation. Bronchoscopy was performed in 47% of activations. Surgical airway rescue was attempted 4 times. Cardiopulmonary resuscitation occurred in 41 activations (25%). Twenty-nine patients died during or following team activation (18%), including 10 deaths associated with the critical airway event. Conclusion Critical airway team activation occurred at least once per week on average. Direct laryngoscopy, tracheal intubation, and bronchoscopic procedures were performed frequently; surgical airway rescue was rare. Most patients had existing risk factors for difficult intubation. Given our rate of serious morbidity and mortality, primary prevention of critical airway events will be a focus of future efforts.

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“…However, in pre-hospital conditions, special care should be taken and thus each patient should be treated as a patient with difficult airways, bearing in mind, among other things, that the patient may have a 'full stomach' as well as present difficulties in visualising the glottis. According to the study, despite the fact that endotracheal intubation is considered by many authors to be the golden standard of airway management, the effectiveness of intubation in emergency medicine is insufficient [3,4].…”

Section: Introductionmentioning

confidence: 99%

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

Karczewska

Smereka

Dąbrowski

et al. 2020

Disaster Emerg Med J

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InTRoDuCTIon:Endotracheal intubation is one of the basic procedures performed in emergency medicine in patients with respiratory insufficiency, inability to maintain airway patency, or apnoea. Rapid performance of the procedure and implementation of ventilation are among the basic principles of rescue procedures. The primary aim of the present systematic review and meta-analysis was to compare the VivaSight single lumen (SL) tube-mounted camera with a standard endotracheal single-lumen tube and direct laryngoscope for endotracheal intubation based on randomised controlled trials of simulation or cadaver trials. The analysis was based on the hypothesis that the use of videolaryngoscopy based on VivaSight SL tube increases the effectiveness of endotracheal intubation, reducing the risk of ineffectiveness of the first intubation attempt and the risk of adverse events, such as dental compression. MATeRIAL AnD MeThoDS:We searched the MEDLINE, EMBASE, Scopus, Cochrane, and Google Scholar databases for randomised, controlled trials and observational studies from 1985 until October 2019, without language restrictions. Grey literature, clinicaltrials.gov, and reference lists of articles were hand searched. We conducted a meta-analysis with random-effects models to evaluate time to intubation, first-pass success rates, overall success rates, dental compression, and glottic view. ReSuLTS:The search located 12 eligible studies. The time of intubation using VivaSight was significantly shorter than that of direct laryngoscopy (MD = -11.29 [-13.10, -9.49], p < 0.001). The efficacy of the first intubation attempt was higher for VivaSight than for double lumen (DL) (96.0% vs. 61.7%; RR = 1.62 [1.40, 1.88], p < 0.001). The meta-analysis showed that the total efficacy of VivaSight intubation compared to direct laryngoscopy was statistically significantly higher (100% vs. 88.9%, RR = 1.11 [1.02, 1.20]; p = 0.02). The glottis visibility assessed as Cormack-Lehane grade I or II was better in VivaSight intubation compared to direct laryngoscopy (100% vs. 90.9%, RR = 1.05 [0.99, 1.12]; p = 0.08). ConCLuSIonS:Our meta-analysis suggests that the VivaSight SL provided better glottic visualisation and shorter intubation time, with improved success rates during different simulated intubation scenarios.

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

Cited by 20 publications

References 27 publications

Cuffed versus uncuffed endotracheal tubes in pediatrics: a meta-analysis

Cuffed versus uncuffed endotracheal tubes in pediatrics: a meta-analysis

Critical Airway Team: A Retrospective Study of an Airway Response System in a Pediatric Hospital

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

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