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

James Peyton; Raymond Park; Steven J Staffa; Stefano Sabato; Thomas W Templeton; Mary Lyn Stein; Annery G Garcia-Marcinkiewicz; Edgar Kiss; John Edem Fiadjoe; Britta von Ungern-Sternberg; Franklin Chiao; Patrick Olomu; David Zurakowski; Pete G Kovatsis; 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

Br J Anaesth. 2021 Jan;126(1):331-339. doi: 10.1016/j.bja.2020.08.010. Epub 2020 Sep 17.

Authors

Collaborators

PeDI Collaborative Investigators:
David Sommerfield¹⁰, Chris Holmes¹¹, Niroop Ravula¹², Christine Jette¹³, Sam Mireles¹³, Clyde Matava¹⁴, Simon Whyte¹⁵, Eduardo Vega¹⁶, Lei Yang¹⁷, Piedad Echeverry-Marin¹⁸, Carolina Perez-Pradilla¹⁸, Elizabeth Starker¹⁹, Jennifer Zieg¹⁹, Judit Szolnoki¹⁹, Angela Lee²⁰, Eugenie Heitmiller²⁰, Mohamed Rehman²¹, Lillian Zamora²¹, Allison Fernandez²¹, Jonathan Meserve²², Solmaletha Bhattacharya²³, Paul Reynolds²⁴, Ian Lewis²⁴, Bishr Haydar²⁴, Megan Therrian²⁴, Linare Sarmiento²⁵, Martina Richtsfeld²⁶, Kumar Belani²⁶, Sara Robertson²⁷, Kumar Sathyamoorthy²⁷, Charles Schrock²⁸, Jurgen de Graaff²⁹, Codruta Soneru³⁰, Neeta Singh³¹, Brad Taicher³², Pilar Castro³³, N R Riveros Perez³³, Paul Stricker³⁴, Justin L Lockman³⁴, Jorge Galvez³⁴, Rebecca Isserman³⁴, Brian Struyk³⁴, Christopher Ward³⁴, Grace Hsu³⁴, Akira Nishisaki³⁴, Ramesh Kodavatiganti³⁴, Luis S Ramos³⁴, Eric Scheu³⁴, Benjamin Bruins³⁴, Tally Goldfarb³⁵, Peter Szmuk³⁵, Ranu Jain³⁶, Maria Matuszczak³⁶, David Polaner³⁷, Agnes Hunyady³⁷, Adrian Bosenberg³⁷, See Tham³⁷, Daniel Low³⁷, Guelay B Rosas³⁸, Lisa K Lee³⁹, Ihab Iyah³⁹, Nicholas Dalesio⁴⁰, Rob Greenberg⁴⁰

Affiliations

¹ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA. Electronic address: James.Peyton@childrens.harvard.edu.
² Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
³ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
⁴ Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Australia; Murdoch Children's Institute, Parkville, Victoria, Australia.
⁵ Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
⁶ Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁷ Department of Anesthesiology and Pain Management, University of Texas Southwestern, Dallas, TX, USA; Division of Pediatric Anesthesiology, Children's Health System, Dallas, TX, USA.
⁸ Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Western Australia, Australia; Department of Paediatric Anaesthesia, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia; Perioperative Medicine Team, Telethon Kid's Institute, Perth, Western Australia, Australia.
⁹ Department of Anesthesiology, Westchester Medical Center Health Network, New York, NY, USA.
¹⁰ Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Australia.
¹¹ Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Victoria, Australia.
¹² Department of Anesthesiology and Pain Medicine, UC Davis Children's Hospital, Davis, CA, USA.
¹³ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, CA, USA.
¹⁴ Department of Anesthesia, The Hospital for Sick Children, Toronto, Canada.
¹⁵ Department of Anesthesiology, Pharmacology and Therapeutics, BC Children's Hospital, Vancouver, Canada.
¹⁶ Department of Anesthesia, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.
¹⁷ Department of Anesthesiology and Perioperative Care, West China Medical Center of Sichuan University, Chengdu, China.
¹⁸ Department of Anesthesiology, Instituto de Ortopedia Infantil Roosevelt, Bogotá, Colombia.
¹⁹ Department of Anesthesiology, Children's Hospital of Colorado, Aurora, CO, USA.
²⁰ Department of Anesthesiology, Pain and Perioperative Medicine, Children's National Medical Center, Washington, DC, USA.
²¹ Department of Anesthesia, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA.
²² Department of Anesthesiology, Spectrum Health Partners Maine, South Portland, ME, USA.
²³ Department of Anesthesia, Critical Care and Pain, Massachusetts General Hospital, Boston, MA, USA.
²⁴ Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, MI, USA.
²⁵ Department of Anesthesiology, National Institute of Pediatrics, Mexico City, Mexico.
²⁶ Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
²⁷ Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS, USA.
²⁸ Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, MO, USA.
²⁹ Department of Anesthesia, Erasmus MC Sophia's Children Hospital Rotterdam, Rotterdam, The Netherlands.
³⁰ Department of Anesthesiology, University of New Mexico, Albuquerque, NM, USA.
³¹ Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, NY, USA.
³² Department of Anesthesiology, Duke University, Durham, NC, USA.
³³ Department of Anesthesiology and Pain Management, Children's Hospital of Cleveland Clinic, Cleveland, OH, USA.
³⁴ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
³⁵ Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children's Health System of Texas, Dallas, TX, USA.
³⁶ Department of Anesthesiology, University of Texas Medical School at Houston, Houston, TX, USA.
³⁷ Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
³⁸ Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
³⁹ Department of Anesthesia, University of California, Los Angeles, CA, USA.
⁴⁰ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA.

PMID: 32950248
DOI: 10.1016/j.bja.2020.08.010

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.

Publication types

Comparative Study
Multicenter Study
Observational Study

MeSH terms

Child
Child, Preschool
Equipment Design
Female
Humans
Intubation, Intratracheal / instrumentation*
Intubation, Intratracheal / methods*
Laryngoscopes
Laryngoscopy / instrumentation*
Laryngoscopy / methods*
Male
Registries*
Retrospective Studies
Video Recording