Association Between Video Laryngoscopy and Adverse Tracheal Intubation-Associated Events in the Neonatal Intensive Care Unit

Pouppirt, Nicole; Nassar, Rula; Napolitano, Natalie; Nawab, Ursula; Nishisaki, Akira; Nadkarni, Vinay; Ades, Anne; Foglia, Elizabeth E.

doi:10.1016/j.jpeds.2018.05.046

Cited by 29 publications

(18 citation statements)

References 18 publications

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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 . These studies differ from adult randomized control data from French medical ICUs, where the first‐attempt success and adverse event rates were not different between videolaryngoscopy (McGrath Macintosh laryngoscope) and direct laryngoscopy .…”

Section: Airway Management In the Pediatric Icu Emergency Departmentsupporting

confidence: 76%

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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Section: Airway Management In the Pediatric Icu Emergency Departmentsupporting

confidence: 76%

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

Fiadjoe

Nishisaki

2020

Pediatric Anesthesia

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“…Based on the risk of difficult TI in small premature neonates, and the potential for adverse events, it seems prudent to have more experienced providers intubate those patients. Consideration should also be given to using videolaryngoscopy and premedication with paralysis as these have both been linked to greater first attempt success and fewer adverse events 10 11 25 26…”

Section: Discussionmentioning

confidence: 99%

“…Overall, first attempt success rates for neonatal TI are approximately 50%, with variation depending on the provider type 4–9. First attempt success rates are higher when using videolaryngoscopy—ranging from 63% to 72%—but are still suboptimal 10 11. Failed TI has been linked to intraventricular haemorrhage and neurodevelopmental impairment in premature infants 12 13.…”

Section: Introductionmentioning

confidence: 99%

Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: a report from the National Emergency Airway Registry for Neonates

Sawyer

Foglia

Ades

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU).DesignRetrospective review of prospectively collected data on intubations performed in the NICU from the National Emergency Airway Registry for Neonates.SettingTen academic NICUs.PatientsNeonates intubated in the NICU at each of the sites between October 2014 and March 2017.Main outcome measuresDifficult intubation was defined as one requiring three or more attempts by a non-resident provider. Patient (age, weight and bedside predictors of difficult intubation), practice (intubation method and medications used), provider (training level and profession) and outcome data (intubation attempts, adverse events and oxygen desaturations) were collected for each intubation.ResultsOut of 2009 tracheal intubations, 276 (14%) met the definition of difficult intubation. Difficult intubations were more common in neonates <32 weeks, <1500 g. The difficult intubation group had a 4.9 odds ratio (OR) for experiencing an adverse event and a 4.2 OR for severe oxygen desaturation. Bedside screening tests of difficult intubation lacked sensitivity (receiver operator curve 0.47–0.53).ConclusionsDifficult intubations are common in the NICU and are associated with adverse event and severe oxygen desaturation. Difficult intubations occur more commonly in small preterm infants. The occurrence of a difficult intubation in other neonates is hard to predict due to the lack of sensitivity of bedside screening tests.

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“…This may be attributed to the curvature angle of the blades which should be greater in pediatrics and also to the fact that they do not necessarily offer better alignment of the oral, pharyngeal and tracheal axis for intubation even though vision is better (36,37). Greater success with videolaryngoscopy has been reported in intensive care settings (38,39). Vendors offer blade sizes ranging from 00 to adult sizes and even devices that can be connected to a cell phone screen.…”

Section: Intubation Devicesmentioning

confidence: 99%

Pediatric airway: What is new in approaches and treatments?

Rivera-Tocancipá

2020

Colomb. J. Anesthesiol.

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Perioperative morbidity and mortality are high among patients in the extremes of life undergoing anesthesia. Complications in children occur mainly as a result of airway management-related events such as difficult approach, laryngospasm, bronchospasm and severe hypoxemia, which may result in cardiac arrest, neurological deficit or death. Reports and new considerations that have changed clinical practice in pediatric airway management have emerged in recent years. This narrative literature review seeks to summarize and detail the findings on the primary cause of morbidity and mortality in pediatric anesthesia and to highlight those things that anesthetists need to be aware of, according to the scientific reports that have been changing practice in pediatric anesthesia. This review focuses on the identification of “new” and specific practices that have emerged over the past 10 years and have helped reduce complications associated with pediatric airway management. At least 9 practices grouped into 4 groups are described: assessment, approach techniques, devices, and algorithms. The same devices used in adults are essentially all available for the management of the pediatric airway, and anesthesia-related morbidity and mortality can be reduced through improved quality of care in pediatrics.

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Association Between Video Laryngoscopy and Adverse Tracheal Intubation-Associated Events in the Neonatal Intensive Care Unit

Abstract: The effect of video laryngoscopy on adverse events during neonatal tracheal intubation is unknown. In this single site retrospective cohort study, video laryngoscopy was independently associated with decreased risk for adverse events during neonatal intubation.

Cited by 29 publications

References 18 publications

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

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

Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: a report from the National Emergency Airway Registry for Neonates

Pediatric airway: What is new in approaches and treatments?

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