Development of a guideline for the management of the unanticipated difficult airway in pediatric practice

Black, Ann E.; Flynn, P. E.; Smith, Helen; Thomas, Mark; Wilkinson, Kathy

doi:10.1111/pan.12615

Cited by 147 publications

(194 citation statements)

References 104 publications

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“…The DAS guideline suggests that SC should be selected if PCC fails 3. However, we think that SC is also not feasible in pediatric patients because there are some special anatomical features to be considered in children.…”

Section: Discussionmentioning

confidence: 99%

“…2). 3 Percutaneous cannula cricothyroidotomy and a jet ventilation system with a long expiratory time are well established in adult emergency airway management 5. It could buy some time until ENT or extracorporeal membrane oxygenation services are available.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, even in adults, PCC with jet ventilation can be associated with significant complications, including surgical emphysema, pneumothorax, and lung injury, and it is believed that the pediatric population is particularly at risk of these complications 3. Moreover, some experts suggest that PCC should not be used in children aged <6 years and surgical cricothyroidotomy/tracheostomy should be preferred because the trachea is far smaller than in adults and risking misplacement and posterior tracheal wall injury 3. Because of these factors, we think that PCC is not appropriate in pediatric CICO.…”

Section: Discussionmentioning

confidence: 99%

“…In published reports, tracheostomy by an ENT doctor was successful in three cases of CICO,3 and the guideline for pediatrics suggests that an emergent tracheostomy should be considered as the first step if an ENT doctor is available. However, it is uncommon for an ENT doctor to always be available in such emergent situations.…”

Section: Discussionmentioning

confidence: 99%

“…In pediatric CICO, the Difficult Airway Society (DAS) guideline suggests some airway rescue techniques 2, 3. However, pediatric CICO is very rare, and this suggestion is mostly based on animal experimental results and expert opinions;3 therefore, further reports are necessary to consider the best strategy for pediatric CICO. We describe a pediatric case of CICO and highlight some educational points.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Management of pediatric ‘cannot intubate, cannot oxygenate’

Okada

Ishii

Sato

et al. 2017

Acute Medicine & Surgery

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Case“Cannot intubate, cannot oxygenate” (CICO) is a rare, life‐threatening situation. We describe a pediatric case of CICO and highlight some educational points.A 3‐year‐old boy who collapsed in the bathtub came to our emergency department. On admission, he went into cardiac arrest probably because of an airway obstruction. We judged his condition as CICO and carried out an emergent tracheostomy after several attempts to perform a cricothyroidotomy failed. We continued resuscitation; however, circulation did not return spontaneously.OutcomeThe child died, and the autopsy showed an airway obstruction caused by idiopathic anaphylaxis or acquired angioedema.ConclusionThis case highlights that it can be anatomically difficult to perform a percutaneous cannula cricothyroidotomy and scalpel cricothyroidotomy safely in pediatric CICO cases. An emergent tracheostomy using the scalpel–finger–bougie technique on the proximal trachea should be considered in such cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Management of pediatric ‘cannot intubate, cannot oxygenate’

Okada

Ishii

Sato

et al. 2017

Acute Medicine & Surgery

View full text Add to dashboard Cite

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Thoracic and Respiratory Emergencies

Billet

2022

Emergency Medicine Simulation Workbook

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Management of the Difficult Airway: An Appraisal of Clinical Practice Guidelines

Fritz

Monos

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveManagement of the difficult airway can be a challenging process, which necessitates actionable recommendations from well‐established guidelines. Herein, clinical practice guideline (CPG) quality is evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.Study DesignA systematic literature search was performed using Scopus, EMBASE, and MEDLINE via PubMed.SettingLiterature database.MethodsData were abstracted from relevant guidelines and appraised by 4 expert reviewers in the 6 domains of quality defined by AGREE II. Intraclass correlation coefficients (ICC) were calculated across domains to quantify interrater reliability.ResultsTwelve guidelines met the inclusion criteria. With a mean quality score of 83.1%, the highest quality guideline was authored by the American Society of Anesthesiologists (ASA). Low‐quality content was observed in CPGs authored by the Japanese Society of Anesthesiologists (JSA) and the Chinese Collaboration Group for Emergency Airway Management (CCGEAM). Overall, deficits were most pronounced in domains describing the involvement of stakeholders, developmental rigor, and editorial independence. These findings were consistent among the panel of independent reviewers, with high ICC inter‐rater reliability scores of 58.0% to 70.0% for the referenced domains.ConclusionBy providing a comprehensive appraisal of guidelines, this report may serve as a reference for clinicians seeking to understand and improve upon the developmental quality of difficult airway management resources. According to AGREE II criteria for the quality of the guideline creation process, the 2022 ASA guideline outperforms its predecessors.

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Development of a guideline for the management of the unanticipated difficult airway in pediatric practice

Abstract: This paper provides the background, available evidence base, and justification for each step in the resultant guidelines and gives a rationale for their use.

Cited by 147 publications

References 104 publications

Management of pediatric ‘cannot intubate, cannot oxygenate’

Management of pediatric ‘cannot intubate, cannot oxygenate’

Thoracic and Respiratory Emergencies

Management of the Difficult Airway: An Appraisal of Clinical Practice Guidelines

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