Trend and Outcomes of Video Laryngoscope Use Across PICUs*

Grunwell, Jocelyn R.; Kamat, Pradip; Miksa, Michael; Krishna, Ashwin; Walson, Karen; Simon, Dennis; Krawiec, Conrad; Breuer, Ryan; Lee, Jan Hau; Gradidge, Eleanor; Tarquinio, Keiko M.; Shenoi, Asha; Shults, Justine; Nadkarni, Vinay; Nishisaki, Akira

doi:10.1097/pcc.0000000000001175

Cited by 47 publications

(39 citation statements)

References 28 publications

(31 reference statements)

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“…The use of videolaryngoscopy was associated with a lower occurrence of TIAEs in pediatric ICU intubations . This is similar to results from a single academic neonatal ICU study .…”

Section: Airway Management In the Pediatric Icu Emergency Departmentsupporting

confidence: 83%

“…While the definition of adverse TIAEs does not include hypoxemia, these are often reported together. Current evidence suggests 1. adverse TIAEs and hypoxemia are common in airway management in the pediatric ICUs, Emergency Department, and neonatal ICUs, 2. patient, clinician, and practice factors are associated with the occurrence of these adverse events, and 3. interdisciplinary quality improvement has helped reduce these events . Pediatric anesthesiologists can partner with nonanesthesiologists to improve the safety of airway management in these clinical locations.…”

Section: Airway Management In the Pediatric Icu Emergency Departmentmentioning

confidence: 99%

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Normal and difficult airways in children: “What’s New”—Current evidence

Fiadjoe

Nishisaki

2020

Pediatric Anesthesia

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Background Pediatric difficult airway is one of the most challenging clinical situations. We will review new concepts and evidence in pediatric normal and difficult airway management in the operating room, intensive care unit, Emergency Department, and neonatal intensive care unit. Methods Expert review of the recent literature. Results Cognitive factors, teamwork, and communication play a major role in managing pediatric difficult airway. Earlier studies evaluated videolaryngoscopes in a monolithic way yielding inconclusive results regarding their effectiveness. There are, however, substantial differences among videolaryngoscopes particularly angulated vs. nonangulated blades which have different learning and use characteristics. Each airway device has strengths and weaknesses, and combining these devices to leverage both strengths will likely yield success. In the pediatric intensive care unit, emergency department and neonatal intensive care units, adverse tracheal intubation–associated events and hypoxemia are commonly reported. Specific patient, clinician, and practice factors are associated with these occurrences. In both the operating room and other clinical areas, use of passive oxygenation will provide additional laryngoscopy time. The use of neuromuscular blockade was thought to be contraindicated in difficult airway patients. Newer evidence from observational studies showed that controlled ventilation with or without neuromuscular blockade is associated with fewer adverse events in the operating room. Similarly, a multicenter neonatal intensive care unit study showed fewer adverse events in infants who received neuromuscular blockade. Neuromuscular blockade should be avoided in patients with mucopolysaccharidosis, head and neck radiation, airway masses, and external airway compression for anticipated worsening airway collapse with neuromuscular blocker administration. Conclusion Clinicians caring for children with difficult airways should consider new cognitive paradigms and concepts, leverage the strengths of multiple devices, and consider the role of alternate anesthetic approaches such as controlled ventilation and use of neuromuscular blocking drugs in select situations. Anesthesiologists can partner with intensive care and emergency department and neonatology clinicians to improve the safety of airway management in all clinical settings.

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“…The use of videolaryngoscopy was associated with a lower occurrence of TIAEs in pediatric ICU intubations . This is similar to results from a single academic neonatal ICU study .…”

Section: Airway Management In the Pediatric Icu Emergency Departmentsupporting

confidence: 83%

Section: Airway Management In the Pediatric Icu Emergency Departmentmentioning

confidence: 99%

Normal and difficult airways in children: “What’s New”—Current evidence

Fiadjoe

Nishisaki

2020

Pediatric Anesthesia

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“…This unexpected finding may be related to variable RT intubation skill level across sites, differences in training structure and clinical opportunities, or selection bias. The center in which RTs did the largest proportion of intubations also had a low AE rate in our report, which suggests that properly trained RTs who receive adequate opportunities can perform intubation 3 (43) 0 (0) 0 (0) 1 (100) 1 (100) Non-severe adverse event 4 (9) 6 (24) 3 (20) 1 (14) 1 (14) 0 (0) 0 (0) 0 (0) 1 (100) Severe adverse event 1 (2) 3 (12) 3 (20) 1 (14) 3 (43) 0 (0) 0 (0) 1 (100) 0 (0)…”

Section: Discussionmentioning

confidence: 68%

Respiratory Therapist Intubation Practice in Pediatric ICUs: A Multicenter Registry Study

et al. 2020

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BACKGROUND: Tracheal intubation by respiratory therapists (RTs) is a well-established practice that has been described primarily in adult and neonatal patients. However, minimal data exist regarding RTs' intubation performance in pediatric ICUs. The purpose of this study was to describe the current landscape of intubations performed by RTs in pediatric ICUs. METHODS: A multicenter quality improvement database, the National Emergency Airway Registry for Children (NEAR4KIDS) was queried from 2015 to 2018. We performed a retrospective analysis of prospectively collected data on subject demographics, indication for intubation, difficult airway history and feature presence, provider discipline, medications, and device. Intubation outcomes included first-attempt and overall success rates, adverse events, and oxygen desaturation (ie, S pO 2 < 80%). Overall intubation success was defined as intubation achieved in^2 attempts. RESULTS: There were 12,056 initial intubation encounters from 46 ICUs, with 109 (0.9%) first attempts performed by RTs. Nine (20%) ICUs reported at least one intubation encounter by RTs. The number of intubations performed by RTs at individual centers ranged from 1 to 46 (RT participation rate: 0.3% to 19.6%). RTs utilized video laryngoscopy more often than other providers (53.2% for RTs vs 28.1% for others, P < .001). RTs' first attempt success (RT 60.6% vs other 69.2%, P 5 .051), overall success (RT 76.2 % vs other 82.4%, P 5 .09), and oxygen desaturation S pO 2 < 80% (RT 16.5% vs other 16.9%, P 5 .91) were similar to other providers. Adverse events were more commonly reported in intubations by RTs versus by other providers (22.9% vs 13.8%, P 5 .006). CONCLUSIONS: RTs infrequently intubate in pediatric ICUs, with success rates similar to other providers but higher adverse event rates. RTs were more likely to use video laryngoscopy than other providers. RTs' intubation participation, success, and adverse event rates varied greatly across pediatric ICUs.

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“…The same study showed fewer tracheal intubation associated events with VL (adjusted OR, 0.57; 95% CI, 0.42–0.77; P < .001). [ 11 ]…”

Section: Introductionmentioning

confidence: 99%

Changing the view: Video versus direct laryngoscopy for intubation in the pediatric emergency department

Couto¹,

Reis²,

Farhat³

et al. 2020

Medicine

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The aim of this study was to compare the success of first-attempt tracheal intubation in pediatric patients >1-year old performed using video versus direct laryngoscopy and compare the frequency of tracheal intubation–associated events and desaturation among these patients. Prospective observational cohort study conducted in an Academic pediatric tertiary emergency department. We compared 50 children intubated with Mcgrath Mac video laryngoscope (VL group) and an historical series of 141 children intubated with direct laryngoscopy (DL group). All patients were aged 1 to 18 years. The first attempt success rates were 68% (34/50) and 37.6% (53/141) in the VL and DL groups ( P < .01), respectively. There was a lower proportion of tracheal intubation–associated events in the VL group (VL, 31.3% [15/50] vs DL, 67.8% [97/141]; P < .01) and no significant differences in desaturation (VL, 35% [14/50] vs DL 51.8% [72/141]; P = .06). The median number of attempts was 1 (range, 1–5) for the VL group and 2 (range, 1–8) for the DL group ( P < .01). Multivariate logistic regression showed that video laryngoscope use was associated with higher chances of first-attempt intubation with an odds ratio of 4.5 (95% confidence interval, 1.9–10.4, P < 0.01). Compared with direct laryngoscopy, VL was associated with higher success rates of first-attempt tracheal intubations and lower rates of tracheal intubation–associated events.

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Trend and Outcomes of Video Laryngoscope Use Across PICUs*

Cited by 47 publications

References 28 publications

Normal and difficult airways in children: “What’s New”—Current evidence

Normal and difficult airways in children: “What’s New”—Current evidence

Respiratory Therapist Intubation Practice in Pediatric ICUs: A Multicenter Registry Study

Changing the view: Video versus direct laryngoscopy for intubation in the pediatric emergency department

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