Rigid Video Laryngoscopy for Intubation in Severe Pierre Robin Sequence: A Retrospective Review

Abstract

Objectives/Hypothesis The anatomy of children with severe Pierre Robin sequence can present a challenge for direct laryngoscopy and intubation. Advanced techniques including flexible fiberoptic laryngoscopic intubation have been described but require highly specialized skill and equipment. Rigid video laryngoscopy is more accessible but has not been described in this population. Study Design Retrospective cohort study. Methods A retrospective review was completed at a tertiary care center of all children between January 2016 and March 2020 with Pierre Robin sequence who underwent a mandibular distraction osteogenesis procedure. Intubation events were collected, and a descriptive analysis was performed. A univariate logistic regression model was applied to direct laryngoscopy and flexible fiberoptic laryngoscopy with rigid video laryngoscopy as a reference. Results Twenty‐five patients were identified with a total of 56 endotracheal events. All patients were successfully intubated. Direct laryngoscopy was successful at first intubation attempt in 47.3% (9/19) of events. Six direct laryngoscopy events required switching to another device. Rigid video laryngoscopy was successful at first intubation attempt in 80.5% (29/36) of events. Two cases required switching to another device. Flexible fiberoptic laryngoscopy was found successful at first intubation attempt in 88.9% (8/9) of events. Direct laryngoscopy was 4 times more likely to fail first intubation attempt when compared to rigid video laryngoscopy (P < .05). There was no significant difference between rigid video laryngoscopy and flexible fiberoptic laryngoscopy for intubation. Conclusions For children with Pierre Robin sequence rigid video laryngoscopy should be considered as a first attempt intubation device both in the operating room and for emergent situations. Level of Evidence 4 Laryngoscope, 131:1647–1651, 2021

Trends in Natural Decannulation in Patients with Robin Sequence: A Twenty-five Year Retrospective Review

“…18,19 Visualizing the airway before intubation via direct laryngoscopy with bronchoscopy, drug-induced sleep endoscopy, or other means is important in selecting the appropriate and least invasive treatment. 20 Prone positioning can help with mild respiratory obstruction by moving the tongue forward but is unlikely to be beneficial in severe cases. 21 Early nasopharyngeal tube placement can help open the airway and has minimal morbidity, and thus can be used to avoid tracheostomy.…”

“…18,19 Visualizing the airway before intubation via direct laryngoscopy with bronchoscopy, drug-induced sleep endoscopy, or other means is important in selecting the appropriate and least invasive treatment. 20…”

Tracheobronchial intubation using flexible bronchoscopy in children with Pierre Robin sequence: Nursing considerations for complications

“…However, in terms of complications, direct laryngoscopy is prone to endanger children’s lives due to a high failure rate of intubation[ 13 ]. Although video-laryngoscopy also has high success rates in difficult tracheal intubation[ 9 ], the reported failure rates and severe complications must be taken into account[ 14 ]. To date, there have been fewer hemodynamic responses and adverse events during endotracheal intubation using FB[ 15 , 16 ].…”

“…However, Yin et al [ 3 ] reported difficult intubation in 71% of children with PRS before surgery. Therefore, the stomatologists strongly recommended that TI using FB was performed for PRS children preoperatively, which had the following advantages: indication of the location of airway obstruction in children, elimination of airway obstruction below the tongue level, and reduction of the difficulty of endotracheal intubation[ 4 , 9 ]. The previous study indicated that endotracheal intubation using FB is safe and effective even in neonates with PRS[ 10 , 11 ].…”

Taking the Natural Exit: Opportunities for Treatment Rightsizing in Fetal Head and Neck Mass

“…[1][2][3] Life-saving and function-preserving airway management strategies are available (see Table 1), but routine delivery presents a limited window for intervention. 4,5 Accordingly, preplanning for delivery strategies such as surgical laryngoscopist/airway surgeon attended delivery (AD) and ex utero intrapartum treatment (EXIT) reduces the time from delivery to intervention and prolongs the window for airway intervention, respectively. 5,6 The simultaneous treatment of mother and baby during delivery greatly increases the decision-making complexity.…”