A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry

PeDI Collaborative Investigators

doi:10.1016/j.bja.2020.08.010

A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry

PeDI Collaborative Investigators

Anesthesiology

Research output: Contribution to journal › Article › peer-review

39 Scopus citations

Abstract

BACKGROUND: The design of a videolaryngoscope blade may affect its efficacy. We classified videolaryngoscope blades as standard and non-standard shapes to compare their efficacy performing tracheal intubation in children enrolled in the Paediatric Difficult Intubation Registry.

METHODS: Cases entered in the Registry from March 2017 to January 2020 were analysed. We compared the success rates of initial and eventual tracheal intubation, complications, and technical difficulties between the two groups and by weight stratification.

RESULTS: Videolaryngoscopy was used in 1313 patients. Standard and non-standard blades were used in 529 and 740 patients, respectively. Both types were used in 44 patients. In children weighing <5 kg, standard blades had significantly greater success than non-standard blades at initial (51% vs 26%, P=0.002) and eventual (81% vs 58%, P=0.002) attempts at tracheal intubation. In multivariable logistic regression analysis, standard blades had 3-fold greater odds of success at initial tracheal intubations compared with non-standard blades (adjusted odds ratio 3.0, 95% confidence interval): 1.32-6.86, P=0.0009). Standard blades had 2.6-fold greater odds of success at eventual tracheal intubation compared with non-standard blades in children weighing <5 kg (adjusted odds ratio 2.6, 95% confidence interval: 1.08-6.25, P=0.033). There was no significant difference found in children weighing ≥5 kg.

CONCLUSIONS: In infants weighing <5 kg, videolaryngoscopy with standard blades was associated with a significantly greater success rate than videolaryngoscopy with non-standard blades. Videolaryngoscopy with a standard blade is a sensible choice for tracheal intubation in children who weigh <5 kg.

Original language	English (US)
Pages (from-to)	331-339
Number of pages	9
Journal	British Journal of Anaesthesia
Volume	126
Issue number	1
DOIs	https://doi.org/10.1016/j.bja.2020.08.010
State	Published - Jan 2021

Bibliographical note

Funding Information:
The authors would also like to thank Julianne Bacsik and Aine Sommerfield for their assistance in editing the manuscript. Supported by internal funding from the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA and the Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at theUniversity of Pennsylvania, Philadelphia, Pennsylvania.

Funding Information:
The authors would also like to thank Julianne Bacsik and Aine Sommerfield for their assistance in editing the manuscript. Supported by internal funding from the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA and the Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at theUniversity of Pennsylvania, Philadelphia, Pennsylvania.

Publisher Copyright:
© 2020 British Journal of Anaesthesia

Keywords

airway
difficult intubation
infant
neonate
paediatric
videolaryngoscopy
Laryngoscopes
Humans
Child, Preschool
Male
Equipment Design
Intubation, Intratracheal/instrumentation
Laryngoscopy/instrumentation
Video Recording
Female
Registries
Retrospective Studies
Child

PubMed: MeSH publication types

Observational Study
Multicenter Study
Journal Article
Comparative Study

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10.1016/j.bja.2020.08.010

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@article{ed4efb01cf844722bb48efb793d7fe31,

title = "A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry",

abstract = "BACKGROUND: The design of a videolaryngoscope blade may affect its efficacy. We classified videolaryngoscope blades as standard and non-standard shapes to compare their efficacy performing tracheal intubation in children enrolled in the Paediatric Difficult Intubation Registry.METHODS: Cases entered in the Registry from March 2017 to January 2020 were analysed. We compared the success rates of initial and eventual tracheal intubation, complications, and technical difficulties between the two groups and by weight stratification.RESULTS: Videolaryngoscopy was used in 1313 patients. Standard and non-standard blades were used in 529 and 740 patients, respectively. Both types were used in 44 patients. In children weighing <5 kg, standard blades had significantly greater success than non-standard blades at initial (51% vs 26%, P=0.002) and eventual (81% vs 58%, P=0.002) attempts at tracheal intubation. In multivariable logistic regression analysis, standard blades had 3-fold greater odds of success at initial tracheal intubations compared with non-standard blades (adjusted odds ratio 3.0, 95% confidence interval): 1.32-6.86, P=0.0009). Standard blades had 2.6-fold greater odds of success at eventual tracheal intubation compared with non-standard blades in children weighing <5 kg (adjusted odds ratio 2.6, 95% confidence interval: 1.08-6.25, P=0.033). There was no significant difference found in children weighing ≥5 kg.CONCLUSIONS: In infants weighing <5 kg, videolaryngoscopy with standard blades was associated with a significantly greater success rate than videolaryngoscopy with non-standard blades. Videolaryngoscopy with a standard blade is a sensible choice for tracheal intubation in children who weigh <5 kg.",

keywords = "airway, difficult intubation, infant, neonate, paediatric, videolaryngoscopy, Laryngoscopes, Humans, Child, Preschool, Male, Equipment Design, Intubation, Intratracheal/instrumentation, Laryngoscopy/instrumentation, Video Recording, Female, Registries, Retrospective Studies, Child",

author = "{PeDI Collaborative Investigators} and James Peyton and Raymond Park and Staffa, {Steven J.} and Stefano Sabato and Templeton, {Thomas W.} and Stein, {Mary Lyn} and Garcia-Marcinkiewicz, {Annery G.} and Edgar Kiss and Fiadjoe, {John Edem} and {von Ungern-Sternberg}, Britta and Franklin Chiao and Patrick Olomu and David Zurakowski and Kovatsis, {Pete G.} and David Sommerfield and Chris Holmes and Niroop Ravula and Christine Jette and Sam Mireles and Clyde Matava and Simon Whyte and Eduardo Vega and Lei Yang and Piedad Echeverry-Marin and Carolina Perez-Pradilla and Elizabeth Starker and Jennifer Zieg and Judit Szolnoki and Angela Lee and Eugenie Heitmiller and Mohamed Rehman and Lillian Zamora and Allison Fernandez and Jonathan Meserve and Solmaletha Bhattacharya and Paul Reynolds and Ian Lewis and Bishr Haydar and Megan Therrian and Linare Sarmiento and Martina Richtsfeld and Kumar Belani and Sara Robertson and Kumar Sathyamoorthy and Charles Schrock and {de Graaff}, Jurgen and Codruta Soneru and Neeta Singh and Brad Taicher and Pilar Castro",

note = "Funding Information: The authors would also like to thank Julianne Bacsik and Aine Sommerfield for their assistance in editing the manuscript. Supported by internal funding from the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children{\textquoteright}s Hospital, Boston, MA, USA and the Department of Anesthesiology and Critical Care Medicine, The Children{\textquoteright}s Hospital of Philadelphia, Perelman School of Medicine at theUniversity of Pennsylvania, Philadelphia, Pennsylvania. Funding Information: The authors would also like to thank Julianne Bacsik and Aine Sommerfield for their assistance in editing the manuscript. Supported by internal funding from the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA and the Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at theUniversity of Pennsylvania, Philadelphia, Pennsylvania. Publisher Copyright: {\textcopyright} 2020 British Journal of Anaesthesia",

year = "2021",

month = jan,

doi = "10.1016/j.bja.2020.08.010",

language = "English (US)",

volume = "126",

pages = "331--339",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Oxford University Press",

number = "1",

}

TY - JOUR

T1 - A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry

AU - PeDI Collaborative Investigators

AU - Peyton, James

AU - Park, Raymond

AU - Staffa, Steven J.

AU - Sabato, Stefano

AU - Templeton, Thomas W.

AU - Stein, Mary Lyn

AU - Garcia-Marcinkiewicz, Annery G.

AU - Kiss, Edgar

AU - Fiadjoe, John Edem

AU - von Ungern-Sternberg, Britta

AU - Chiao, Franklin

AU - Olomu, Patrick

AU - Zurakowski, David

AU - Kovatsis, Pete G.

AU - Sommerfield, David

AU - Holmes, Chris

AU - Ravula, Niroop

AU - Jette, Christine

AU - Mireles, Sam

AU - Matava, Clyde

AU - Whyte, Simon

AU - Vega, Eduardo

AU - Yang, Lei

AU - Echeverry-Marin, Piedad

AU - Perez-Pradilla, Carolina

AU - Starker, Elizabeth

AU - Zieg, Jennifer

AU - Szolnoki, Judit

AU - Lee, Angela

AU - Heitmiller, Eugenie

AU - Rehman, Mohamed

AU - Zamora, Lillian

AU - Fernandez, Allison

AU - Meserve, Jonathan

AU - Bhattacharya, Solmaletha

AU - Reynolds, Paul

AU - Lewis, Ian

AU - Haydar, Bishr

AU - Therrian, Megan

AU - Sarmiento, Linare

AU - Richtsfeld, Martina

AU - Belani, Kumar

AU - Robertson, Sara

AU - Sathyamoorthy, Kumar

AU - Schrock, Charles

AU - de Graaff, Jurgen

AU - Soneru, Codruta

AU - Singh, Neeta

AU - Taicher, Brad

AU - Castro, Pilar

N1 - Funding Information: The authors would also like to thank Julianne Bacsik and Aine Sommerfield for their assistance in editing the manuscript. Supported by internal funding from the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA and the Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at theUniversity of Pennsylvania, Philadelphia, Pennsylvania. Funding Information: The authors would also like to thank Julianne Bacsik and Aine Sommerfield for their assistance in editing the manuscript. Supported by internal funding from the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA and the Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at theUniversity of Pennsylvania, Philadelphia, Pennsylvania. Publisher Copyright: © 2020 British Journal of Anaesthesia

PY - 2021/1

Y1 - 2021/1

N2 - BACKGROUND: The design of a videolaryngoscope blade may affect its efficacy. We classified videolaryngoscope blades as standard and non-standard shapes to compare their efficacy performing tracheal intubation in children enrolled in the Paediatric Difficult Intubation Registry.METHODS: Cases entered in the Registry from March 2017 to January 2020 were analysed. We compared the success rates of initial and eventual tracheal intubation, complications, and technical difficulties between the two groups and by weight stratification.RESULTS: Videolaryngoscopy was used in 1313 patients. Standard and non-standard blades were used in 529 and 740 patients, respectively. Both types were used in 44 patients. In children weighing <5 kg, standard blades had significantly greater success than non-standard blades at initial (51% vs 26%, P=0.002) and eventual (81% vs 58%, P=0.002) attempts at tracheal intubation. In multivariable logistic regression analysis, standard blades had 3-fold greater odds of success at initial tracheal intubations compared with non-standard blades (adjusted odds ratio 3.0, 95% confidence interval): 1.32-6.86, P=0.0009). Standard blades had 2.6-fold greater odds of success at eventual tracheal intubation compared with non-standard blades in children weighing <5 kg (adjusted odds ratio 2.6, 95% confidence interval: 1.08-6.25, P=0.033). There was no significant difference found in children weighing ≥5 kg.CONCLUSIONS: In infants weighing <5 kg, videolaryngoscopy with standard blades was associated with a significantly greater success rate than videolaryngoscopy with non-standard blades. Videolaryngoscopy with a standard blade is a sensible choice for tracheal intubation in children who weigh <5 kg.

AB - BACKGROUND: The design of a videolaryngoscope blade may affect its efficacy. We classified videolaryngoscope blades as standard and non-standard shapes to compare their efficacy performing tracheal intubation in children enrolled in the Paediatric Difficult Intubation Registry.METHODS: Cases entered in the Registry from March 2017 to January 2020 were analysed. We compared the success rates of initial and eventual tracheal intubation, complications, and technical difficulties between the two groups and by weight stratification.RESULTS: Videolaryngoscopy was used in 1313 patients. Standard and non-standard blades were used in 529 and 740 patients, respectively. Both types were used in 44 patients. In children weighing <5 kg, standard blades had significantly greater success than non-standard blades at initial (51% vs 26%, P=0.002) and eventual (81% vs 58%, P=0.002) attempts at tracheal intubation. In multivariable logistic regression analysis, standard blades had 3-fold greater odds of success at initial tracheal intubations compared with non-standard blades (adjusted odds ratio 3.0, 95% confidence interval): 1.32-6.86, P=0.0009). Standard blades had 2.6-fold greater odds of success at eventual tracheal intubation compared with non-standard blades in children weighing <5 kg (adjusted odds ratio 2.6, 95% confidence interval: 1.08-6.25, P=0.033). There was no significant difference found in children weighing ≥5 kg.CONCLUSIONS: In infants weighing <5 kg, videolaryngoscopy with standard blades was associated with a significantly greater success rate than videolaryngoscopy with non-standard blades. Videolaryngoscopy with a standard blade is a sensible choice for tracheal intubation in children who weigh <5 kg.

KW - airway

KW - difficult intubation

KW - infant

KW - neonate

KW - paediatric

KW - videolaryngoscopy

KW - Laryngoscopes

KW - Humans

KW - Child, Preschool

KW - Male

KW - Equipment Design

KW - Intubation, Intratracheal/instrumentation

KW - Laryngoscopy/instrumentation

KW - Video Recording

KW - Female

KW - Registries

KW - Retrospective Studies

KW - Child

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U2 - 10.1016/j.bja.2020.08.010

DO - 10.1016/j.bja.2020.08.010

M3 - Article

C2 - 32950248

AN - SCOPUS:85090482301

SN - 0007-0912

VL - 126

SP - 331

EP - 339

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 1

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A comparison of videolaryngoscopy using standard blades or non-standard blades in children in the Paediatric Difficult Intubation Registry

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

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