Pediatric airway management devices: an update on recent advances and future directions

Tsao, Michelle; Vargas, Angelica Anne; Hajduk, John; Singh, Renee; Jagannathan, Narasimhan

doi:10.1080/17434440.2018.1549483

Cited by 8 publications

(6 citation statements)

References 58 publications

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“…There is no consensus on the optimal device for pediatric endotracheal intubation due to the anatomical and physiological differences between the airways of pediatric and adult patients 2 . A previous meta-analysis 1 showed that, compared with direct laryngoscopy intubation, intubation with videolaryngoscopy devices did not significantly reduce first attempt failure and lower TTI.…”

Section: Discussionmentioning

confidence: 99%

“…Endotracheal intubation maintains airway patency in children with or without a difficult airway and protects the airway in patients with altered mental status 1 . The pediatric airway differs distinctively from the adult airway in both anatomy and physiology 2 , which include thinner and tender trachea, weaker respiratory muscles, incomplete bone growth, poor intubation tolerance, and increased oxygen demand with low oxygen reserves 3 , making pediatric intubation a great challenge. Consequently, multiple attempts at intubation in children can lead to complications such as the inability to ventilate or intubate leading to hypoxia, pharyngeal and laryngeal injuries, and airway oedema 4 .…”

Section: Introductionmentioning

confidence: 99%

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Network meta-analysis of comparative efficacy and safety of intubation devices in children

Ming,

Chu,

Yang

et al. 2023

Sci Rep

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To evaluate the comparative efficacy and safety of different intubation devices on intubation outcomes in pediatric intubation. We identified relevant studies from previous meta-analyses and literature retrieval in PubMed, EMBASE, and Cochrane Library. The primary outcome was the first-pass success (FPS), and the secondary outcome included the time to intubation (TTI) and the risk of local complications (LC). Network meta-analysis was performed using STATA 14.0. Twenty-three randomized comparative trials (RCTs) including 12 devices were included. Compared with Macintosh, Airtraq (odds ratio [OR] = 13.05, 95% confidence interval [CI] = 4.68 to 36.38), Miller (OR = 4.77, 95%CI = 1.32 to 17.22), Glidescope (OR = 2.76, 95%CrI = 1.60 to 4.75) and McGrath (OR = 4.61, 95%CI = 1.18 to 17.99) obtained higher PFS. Meanwhile, Airtraq was superior to Glidescope (OR = 0.21, 95%CI = 0.07 to 0.65) for PFS. For TTI, Canada was superior to other intubation devices, as well as CMAC was superior to TruViewEVO2, Glidescope, and StorzDCI. Airtraq lowered the risk of LC compared with Macintosh and Pentax but there was no statistical difference between Airtraq and KingVision. Airtraq may be the optimal option for FPS, Canada for TTI, and KingVision for LC in pediatric intubation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Network meta-analysis of comparative efficacy and safety of intubation devices in children

Ming,

Chu,

Yang

et al. 2023

Sci Rep

View full text Add to dashboard Cite

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“…However, there are several setbacks to indirect video laryngoscopy: Good hand-eye coordination is needed; it cannot be used in patients with limited mouth opening and/or copious intraoral secretion or blood as secretion and blood will obstruct the lens. (12,13) In patients potentially di cult to ventilate, awake FOB can be a choice if there are no other safer options, especially for special populations, such as infants and neonates. Airway block can be performed on cooperative patients if local anaesthetic nebulization is impossible.…”

Section: Performance Errorsmentioning

confidence: 99%

“…Pressure and stress when facing a di cult airway can lead to a signi cant increase in errors. (3,12,16,17) Not all airways devices can be used in every different situation. Recognizing the advantages and disadvantages of every device used before a procedure could help the operator to arrange a plan.…”

Section: Pro Ciency Errorsmentioning

confidence: 99%

Handling Error Traps in Difficult Airway Management in Paediatric Patients With Mandible Tumour: Lessons Learned From Two Cases

Zahrah

Untari

Pramodana

et al. 2022

Preprint

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Introduction Various factors can cause difficult airways in the paediatric population, such as congenital anomalies, obstruction, tumours, etc. Failure in managing difficult airways in children is associated with significant morbidity and mortality. We present a case series of how identifying error traps will improve patient care and safety. Case We present two similar cases of children with impending airway obstruction due to mandible tumours who were indicated for an urgent tracheostomy. In the first case, there was an airway management failure (cannot intubate, cannot oxygenate). The patient deteriorated rapidly and died in the operating theatre. Aftermath, we conducted a multidisciplinary discussion of experts and analysed this sentinel case. In the first case, there were some error traps related to preparation, performance, and proficiency. Thus, recommendations were advised. The second case occurred 14 days following the first one. This time we delivered the airway management by implementing the recommendation from previous case failures, which were: choosing the appropriate anaesthesia technique and airway device, performing adequate passive oxygenation before an intubation attempt, having a mitigation plan, and communicating it with the surgeon. Also, an airway expert should always be available to be consulted. Lastly, conducting a debriefing with the team involved after the procedure to identify the experienced problems. The team managed to perform the tracheostomy on the second child successfully. Conclusion Mortality and morbidity due to airway management failure in paediatric patients with difficult airways could be reduced by averting error traps and following the recommendation to have better preparation in airway management techniques and planning, good inter-team communication and coordination, and consult a more experienced anaesthesiologist to lead the team.

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“…Pediatric patients are anatomically smaller than adults, and the narrowness of their oral cavity, small glottis, and large tongue make tracheal intubation difficult [1]. Furthermore, hypoxia is likely to occur because of immature lung growth, and anesthesiologists are required to perform rapid tracheal intubation [2].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis

Takeuchi,

Hoshijima,

Mihara

et al. 2023

Children

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This meta-analysis was performed to determine whether an indirect laryngoscope is more advantageous than a direct laryngoscope for tracheal intubation in the setting of a difficult pediatric airway. Data on the intubation failure and intubation time during tracheal intubation were extracted from prospective and retrospective studies identified through a comprehensive literature search. Data from 10 individual articles (11 trials) were combined, and a DerSimonian and Laird random-effects model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) and the corresponding 95% confidence interval (CI). Meta-analysis of the 10 articles indicated that the intubation failure of tracheal intubation with an indirect laryngoscope was not significantly different from that of a direct laryngoscope in patients with a difficult airway (RR 0.86, 95% CI 0.51–1.46; p = 0.59; Cochrane’s Q = 50.5; I2 = 82%). Intubation time with an indirect laryngoscope was also similar to that with a direct laryngoscope (WMD 4.06 s; 95% CI −1.18–9.30; p = 0.13; Cochrane’s Q 39.8; I2 = 85%). In conclusion, indirect laryngoscopes had the same intubation failure and intubation time as direct laryngoscopes in pediatric patients with a difficult airway. Currently, the benefits of indirect laryngoscopes have not been observed in the setting of a difficult pediatric airway.

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Pediatric airway management devices: an update on recent advances and future directions

Cited by 8 publications

References 58 publications

Network meta-analysis of comparative efficacy and safety of intubation devices in children

Network meta-analysis of comparative efficacy and safety of intubation devices in children

Handling Error Traps in Difficult Airway Management in Paediatric Patients With Mandible Tumour: Lessons Learned From Two Cases

Comparison of Indirect and Direct Laryngoscopes in Pediatric Patients with a Difficult Airway: A Systematic Review and Meta-Analysis

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