Utility of fiberoptic bronchoscopy for difficult airway in neonates

Cobo, Pilar; Vetter-Laracy, Susanne; Beltran, Eva; Peña-Zarza, Jose Antonio; Figuerola, Joan; Osona, Borja

doi:10.1080/14767058.2019.1670801

Cited by 9 publications

(9 citation statements)

References 18 publications

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“…The inclusion of the video bronchoscope allows providers without this specialized training to effectively utilize the airway emergency cart [ 13 ]. For example, in a single-center retrospective study of 66 bronchoscopies performed on newborns using a flexible bronchoscope, six were done for emergency tracheal intubation and all were successful [ 14 ]. Thus, intubation using a flexible bronchoscope is a safe and effective method for securing the airway in an emergency setting [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Quality Improvement of Pediatric Airway Emergency Carts: Standardization, Streamlining, and Simulation

Fleishhacker,

Bennion,

Manaligod

et al. 2023

Cureus

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Objective Pediatric airway emergencies are amongst the most tenuous scenarios faced by on-call providers, requiring quick access to the appropriate equipment and a timely response. In the present study, we report on the testing and improvement of pediatric airway carts at our institution. The primary objective was to optimize our pediatric airway emergency carts to improve response times. Secondarily, we aimed to implement a training scenario to improve providers’ familiarity and confidence in attaining and assembling equipment. Methods Surveys of airway cart configuration at our hospital and others were used to identify differences. Volunteer otolaryngology physicians were tasked with responding to a mock scenario using an existing cart or one modified based on the survey. Outcomes included (1) time to arrival of the provider with the appropriate equipment, (2) time from arrival to complete assembly of equipment, and (3) time for re-assembly of the equipment. Results The survey revealed differences in cart equipment and location. The inclusion of a flexible bronchoscope and a video tower, as well as the placement of the carts directly within the ICU, resulted in improved time to arrival by an average of 181 seconds, and improved equipment assembly time by an average of 85 seconds. Discussion Standardization of pediatric airway equipment on the cart and location near critically ill patients improved response efficiency. Simulation led to improved confidence and reduced reaction time among providers at all levels of experience. Conclusion The present study provides an example for the optimization of airway carts, which can be adapted by healthcare systems to their local milieu.

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Section: Discussionmentioning

confidence: 99%

Quality Improvement of Pediatric Airway Emergency Carts: Standardization, Streamlining, and Simulation

Fleishhacker,

Bennion,

Manaligod

et al. 2023

Cureus

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“…Emerging studies have investigated and promoted the use of multiple tools for difficult airway assessment and management. 7,8 Guidelines for difficult airway management have been developed and continuously updated regularly. 5,[9][10][11][12][13] Seminars and training that focus on managing difficult airways are commonly conducted in most institutes.…”

Section: Referencesmentioning

confidence: 99%

“…Continuous efforts have been made to decrease the mortality and morbidity associated with difficult airways. Emerging studies have investigated and promoted the use of multiple tools for difficult airway assessment and management 7,8 . Guidelines for difficult airway management have been developed and continuously updated regularly 5,9–13 .…”

mentioning

confidence: 99%

Current Status of Difficult Airway Information Dissemination at a Tertiary Pediatric Hospital

Shi,

Lan,

Zhang

et al. 2024

Journal of Craniofacial Surgery

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Objective: Difficult airway is one of the most common potential risk factors for increased fatality in craniofacial/plastic surgery patients. To date, there is no well-established and all-around difficult airway notification system in China, which has recently been recommended by existing guidelines to improve the care of patients with known difficult airways. This study aimed to investigate the current status of critical information communication concerning difficult airway management in our institute. Methods: Vital information required to establish a difficult airway registry and notification system was collected through a literature review and expert suggestions. After approval by the Research Ethics Board, 3 online questionnaires were developed and sent to surgeons, anesthesiologists, and proxies of the patients. Knowledge of difficult airways, the willingness to be involved in the difficult airway notification system, and the way to disseminate the information were investigated in the 3 groups. The specific information that was disseminated, required, and available was investigated in the anesthesiologist group. Results: Compared with the surgeons and anesthesiologists, significantly fewer patients knew the definition of a difficult airway and thought it was a potential risk factor. There were no significant differences in the willingness to be informed of the difficulty encountered during airway management. Significant differences were detected in the willingness and way to disseminate the airway information when the participants communicated with different groups. Significantly more patients would disseminate the information to the surgeon and significantly more surgeons would disseminate the information to the patient and the other surgeon. Significantly more anesthesiologists would disseminate the information to the patient and the other anesthesiologists. A significant difference was observed between what was expected and what was available for the anesthesiologist to retrieve the airway information of a patient with known airway difficulty. Significantly more anesthesiologists would notify only the patient of the diagnosis of a difficult airway both oral and written, whereas significantly more anesthesiologists would notify the other anesthesiologist of the specific difficulties in oral only. Most participants agreed to be involved in the difficult airway notification system despite the significantly lower percentage in the patient group (89%). Conclusions: Difficult airway information dissemination is, at the time of this writing, ineffective, which leads to a large gap between the expectation and practice of the anesthesiologist when caring for a patient with a difficult airway. Thus, a difficult airway registry and notification system should be developed, that has a solid foundation in all the participants.

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“…The "gold standard" for difficult pediatric airway management is fiberoptic-guided ETI, i.e., fiberoptic bronchoscopy (FOB). However, there is a paucity of data on neonatal use of FOB during intubation and controlled extubation (43,44). The technique of using a SAD as a conduit for FOB-guided intubation may reduce blurring of the vision caused by blood and secretions (45) and is recommended as an option to resolve the unanticipated difficult airway situation in children (29).…”

Section: Fiberoptic Intubationmentioning

confidence: 99%

“…The technique of using a SAD as a conduit for FOB-guided intubation may reduce blurring of the vision caused by blood and secretions (45) and is recommended as an option to resolve the unanticipated difficult airway situation in children (29). Recent case reports and studies conclude that the technique is an effective and safe option in the anticipated and unanticipated difficult airway in neonates and infants (43,44).…”

Section: Fiberoptic Intubationmentioning

confidence: 99%

Management of the Unexpected Difficult Airway in Neonatal Resuscitation

et al. 2021

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A “difficult airway situation” arises whenever face mask ventilation, laryngoscopy, endotracheal intubation, or use of supraglottic device fail to secure ventilation. As bradycardia and cardiac arrest in the neonate are usually of respiratory origin, neonatal airway management remains a critical factor. Despite this, a well-defined in-house approach to the neonatal difficult airway is often lacking. While a recent guideline from the British Pediatric Society exists, and the Scottish NHS and Advanced Resuscitation of the Newborn Infant (ARNI) airway management algorithm was recently revised, there is no Norwegian national guideline for managing the unanticipated difficult airway in the delivery room (DR) and neonatal intensive care unit (NICU). Experience from anesthesiology is that a “difficult airway algorithm,” advance planning and routine practicing, prepares the resuscitation team to respond adequately to the technical and non-technical stress of a difficult airway situation. We learned from observing current approaches to advanced airway management in DR resuscitations in a university hospital and make recommendations on how the neonatal difficult airway may be managed through technical and non-technical approaches. Our recommendations mainly pertain to DR resuscitations but may be transferred to the NICU environment.

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Utility of fiberoptic bronchoscopy for difficult airway in neonates

Cited by 9 publications

References 18 publications

Quality Improvement of Pediatric Airway Emergency Carts: Standardization, Streamlining, and Simulation

Quality Improvement of Pediatric Airway Emergency Carts: Standardization, Streamlining, and Simulation

Current Status of Difficult Airway Information Dissemination at a Tertiary Pediatric Hospital

Management of the Unexpected Difficult Airway in Neonatal Resuscitation

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