Awake Supraglottic Airway Placement in Pediatric Patients for Airway Obstruction or Difficult Intubation: Insights From an International Airway Registry (PeDI).
Journal
Anesthesia and analgesia
ISSN: 1526-7598
Titre abrégé: Anesth Analg
Pays: United States
ID NLM: 1310650
Informations de publication
Date de publication:
24 Oct 2024
24 Oct 2024
Historique:
medline:
25
10
2024
pubmed:
25
10
2024
entrez:
24
10
2024
Statut:
aheadofprint
Résumé
Small case series have described awake supraglottic airway placement in infants with significant airway obstruction and difficult intubations. We conducted this study to determine outcomes when supraglottic airways were placed in awake children enrolled in the international Pediatric Difficult Intubation Registry including success of ventilation, success of tracheal intubation, and complications. We reviewed the Pediatric Difficult Intubation Registry to identify all cases of awake supraglottic airway placement before planned tracheal intubation from August 2012 to September 2023 with subsequent review of details of awake supraglottic airway placement in the medical record. We present descriptive statistics of patient demographics, ventilation and intubation outcomes, and complications. A supraglottic airway was placed in an awake child in 95 of 8061 (1.2%) cases in the Pediatric Difficult Intubation Registry. Median age was 37 days (range 0-17.6 years) and median weight was 3.7 kg (1.6-46.7 kg). Sixteen (17%) cases were in patients older than 2 years and 7 (7%) were in adolescents. Adequate ventilation via a supraglottic airway was achieved in 81/95 (85%, 95% confidence interval [CI], 77%-93%) encounters. Inadequate (n = 13) or impossible (n = 1) ventilation occurred in 14/95 (15%). No complications were reported with supraglottic airway placement. For subsequent intubation, there was a 35% (33/95) first-attempt success rate and 99% (94/95) eventual success, with 1 patient awakened after failed attempts at tracheal intubation. Hypoxia occurred during the first intubation attempt in 9/95 (9%) encounters. The incidence of hypoxia was lower in encounters in which ventilation via the supraglottic airway was adequate (4/81, 5%) than in encounters in which ventilation via the supraglottic airway was inadequate or impossible (5/14, 36%). Although infrequently attempted, awake placement of a supraglottic airway in children with difficult airways achieved adequate ventilation and provided a conduit for oxygenation and ventilation after induction of anesthesia across a spectrum of ages.
Sections du résumé
BACKGROUND
BACKGROUND
Small case series have described awake supraglottic airway placement in infants with significant airway obstruction and difficult intubations. We conducted this study to determine outcomes when supraglottic airways were placed in awake children enrolled in the international Pediatric Difficult Intubation Registry including success of ventilation, success of tracheal intubation, and complications.
METHODS
METHODS
We reviewed the Pediatric Difficult Intubation Registry to identify all cases of awake supraglottic airway placement before planned tracheal intubation from August 2012 to September 2023 with subsequent review of details of awake supraglottic airway placement in the medical record. We present descriptive statistics of patient demographics, ventilation and intubation outcomes, and complications.
RESULTS
RESULTS
A supraglottic airway was placed in an awake child in 95 of 8061 (1.2%) cases in the Pediatric Difficult Intubation Registry. Median age was 37 days (range 0-17.6 years) and median weight was 3.7 kg (1.6-46.7 kg). Sixteen (17%) cases were in patients older than 2 years and 7 (7%) were in adolescents. Adequate ventilation via a supraglottic airway was achieved in 81/95 (85%, 95% confidence interval [CI], 77%-93%) encounters. Inadequate (n = 13) or impossible (n = 1) ventilation occurred in 14/95 (15%). No complications were reported with supraglottic airway placement. For subsequent intubation, there was a 35% (33/95) first-attempt success rate and 99% (94/95) eventual success, with 1 patient awakened after failed attempts at tracheal intubation. Hypoxia occurred during the first intubation attempt in 9/95 (9%) encounters. The incidence of hypoxia was lower in encounters in which ventilation via the supraglottic airway was adequate (4/81, 5%) than in encounters in which ventilation via the supraglottic airway was inadequate or impossible (5/14, 36%).
CONCLUSIONS
CONCLUSIONS
Although infrequently attempted, awake placement of a supraglottic airway in children with difficult airways achieved adequate ventilation and provided a conduit for oxygenation and ventilation after induction of anesthesia across a spectrum of ages.
Identifiants
pubmed: 39446662
doi: 10.1213/ANE.0000000000006959
pii: 00000539-990000000-01008
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Benjamin B Bruins
(BB)
Paul Stricker
(P)
Elizabeth K Laverriere
(EK)
Justin L Lockman
(JL)
Brian Struyk
(B)
Christopher Ward
(C)
Akira Nishisaki
(A)
Ramesh Kodavatiganti
(R)
Rodrigo J Daly Guris
(RJD)
Luis Sequera-Ramos
(L)
Mark S Teen
(MS)
Ayodele Oke
(A)
Grace Hsu
(G)
Arul Lingappan
(A)
Chinyere Egbuta
(C)
Stephen Flynn
(S)
Lina Sarmiento
(L)
Rhae Battles
(R)
Ashley D Bocanegra
(AD)
Tally Goldfarb
(T)
Edgar E Kiss
(EE)
Patrick N Olomu
(PN)
Peter Szmuk
(P)
Sam Mireles
(S)
Andrea Murray
(A)
Simon Whyte
(S)
Ranu Jain
(R)
Sabina A Khan
(SA)
Maria Matuszczak
(M)
Agnes Hunyady
(A)
Christopher Holmes
(C)
Alexander McCann
(A)
Stefano Sabato
(S)
Clyde Matava
(C)
Nicholas Dalesio
(N)
Robert Greenberg
(R)
Angela Lucero
(A)
Sapna Desai
(S)
Nashville Tennessee
(N)
Sondra Rosander
(S)
Sindhu Samba
(S)
Charles Schrock
(C)
Sydney Nykiel-Bailey
(S)
Jennifer Marsh
(J)
Melissa Brooks Peterson
(M)
Amy Colleen Johnson Lee
(AC)
Somaletha Bhattacharya
(S)
Nicholas E Burjek
(NE)
Narasimhan Jagannathan
(N)
David Lardner
(D)
Christy Crockett
(C)
Sara Robertson
(S)
Madhankumar Sathyamoorthy
(M)
Franklin Chiao
(F)
Jasmine Patel
(J)
Aarti Sharma
(A)
Piedad Echeverry Marin
(P)
Carolina Pérez-Pradilla
(C)
Neeta Singh
(N)
Brad Taicher
(B)
Britta S von Ungern-Sternberg
(BS)
David Sommerfield
(D)
Neil Hauser
(N)
Emily Hesselink
(E)
Hilana Lewkowitz-Shpuntoff
(H)
Pilar Castro
(P)
N Ricardo Riveros Perez
(NR)
Fernanda Leite
(F)
Eduardo Vega
(E)
Alejandro González
(A)
Paola Ostermann
(P)
Kasia Rubin
(K)
Angela Lee
(A)
Songyos Valairucha
(S)
Priti Dalal
(P)
Thanh Tran
(T)
Taylor Anspach
(T)
Lisa K Lee
(LK)
Ihab Ayad
(I)
Mohamed Rehman
(M)
Allison Fernandez
(A)
Lillian Zamora
(L)
Niroop Ravula
(N)
Sadiq Shaik
(S)
Judit Szolnoki
(J)
Preethy J Mathew
(PJ)
Sandhya Yaddanapudi
(S)
Indu Sen
(I)
Aakriti Gupta
(A)
Kathryn Handlogten
(K)
J Michael Sroka
(JM)
Vinicius Caldeira Quintao
(V)
Ricardo Vieira Carlos
(R)
Informations de copyright
Copyright © 2024 International Anesthesia Research Society.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
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