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Wenyu Bai, Kristine Golmirzaie, Constance Burke, Tara Van Veen, Robert Christensen, Terri Voepel-Lewis, Shobha Malviya
BACKGROUND AND OBJECTIVES: There are limited data on pediatric emergency tracheal intubation on inpatient units and in the emergency department by anesthesiologists. This retrospective cohort study was designed to describe the frequency of difficult intubation and adverse events associated with emergency tracheal intubation performed by pediatric anesthesiologists in a large children's hospital. METHODS: All emergency tracheal intubation on inpatient units and the emergency department performed by pediatric anesthesiologists over a 7-year period in children <18 years were identified by querying our perioperative clinical information system...
April 2016: Paediatric Anaesthesia
Krithika Lingappan, Jennifer L Arnold, Thomas L Shaw, Caraciolo J Fernandes, Mohan Pammi
BACKGROUND: Establishment of secure airway is a critical part of neonatal resuscitation both in the delivery room and in the neonatal unit. Videolaryngoscopy is a new technique that has the potential to facilitate successful endotracheal intubation and decrease adverse consequences of delay in airway stabilization. Videolaryngoscopy may enhance visualization of the glottis and intubation success in neonates. OBJECTIVES: To determine the efficacy and safety of videolaryngoscopy compared to direct laryngoscopy in decreasing the time and attempts required and increasing the success rate for endotracheal intubation in neonates...
February 18, 2015: Cochrane Database of Systematic Reviews
Aida Field-Ridley, Viyeka Sethi, Shweta Murthi, Kiran Nandalike, Su-Ting T Li
AIM: To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to flexible fiberoptic bronchoscopy (FFB) in critically ill children. METHODS: We searched PubMed, SCOPUS, OVID, and EMBASE databases through July 2014 for English language publications studying FFB performed in the intensive care unit in children < 18 years old. We identified 666 studies, of which 89 full-text studies were screened for further review. Two reviewers independently determined that 27 of these studies met inclusion criteria and extracted data...
February 4, 2015: World Journal of Critical Care Medicine
Ann E Black, Paul E R Flynn, Helen L Smith, Mark L Thomas, Kathy A Wilkinson
BACKGROUND: Most airway problems in children are identified in advance; however, unanticipated difficulties can arise and may result in serious complications. Training for these sporadic events can be difficult. We identified the need for a structured guideline to improve clinical decision making in the acute situation and also to provide a guide for teaching. OBJECTIVE: Guidelines for airway management in adults are widely used; however, none have been previously devised for national use in children...
April 2015: Paediatric Anaesthesia
Sarah L Prunty, Alberto Aranda-Palacios, Andy M Heard, Gordon Chapman, Anoop Ramgolam, Mary Hegarty, Shyan Vijayasekaran, Britta S von Ungern-Sternberg
BACKGROUND: While the majority of pediatric intubations are uncomplicated, the 'Can't intubate, Can't Oxygenate' scenario (CICO) does occur. With limited management guidelines available, CICO is still a challenge even to experienced pediatric anesthetists. OBJECTIVES: To compare the COOK Melker cricothyroidotomy kit (CM) with a scalpel bougie (SB) technique for success rate and complication rate in a tracheotomy on a cadaveric 'infant airway' animal model. METHODS: Two experienced proceduralists repeatedly attempted tracheotomy in eight rabbits, alternately using CM and SB (4 fr) technique...
April 2015: Paediatric Anaesthesia
Edwardina M M A Lillie, Louise Harding, Mark Thomas
Difficult intubation of a 2.4 kg ex premature, suspected Pierre Robin Sequence with upper airway obstruction causing respiratory failure. Multiple failed intubation attempts by an experienced pediatric anesthetist using described techniques and adjuncts. A description of a simple new maneuvre using a GlideScope and a stylet. By twisting the stylet into a spiral shape, the endotracheal tube was given improved maneuverability that allowed the intubator to place the endotracheal tube tip to the glottis opening...
April 2015: Paediatric Anaesthesia
Y Passi, M Sathyamoorthy, J Lerman, C Heard, M Marino
BACKGROUND: Miller laryngoscope blades are preferred for laryngoscopy in infants and children <2 yr of age. Despite their long history, the laryngeal view with the Miller blade size 1 has never been compared with that with the Macintosh (MAC) blade in children. This prospective, single-blinded, randomized study was designed to compare the laryngeal views with the size 1 Miller and MAC blades in children <2 yr. METHODS: With IRB approval, 50 ASA I and II children <2 yr undergoing elective surgery were enrolled...
November 2014: British Journal of Anaesthesia
Elliot Long, Stefan Sabato, Franz E Babl
BACKGROUND AND OBJECTIVES: Prospective safety data on emergency department (ED) intubation in children are limited. We aimed to describe the practice and adverse events associated with endotracheal intubation in a large urban pediatric ED. METHODS: Prospective observational study at a tertiary pediatric ED with an annual census of 82,000. The primary outcome measure was the adverse event rate. Secondary outcome measures were incidence of difficult laryngoscopy and first pass success rate without desaturation or hypotension...
December 2014: Paediatric Anaesthesia
Yu Sun, Yi Lu, Yan Huang, Hong Jiang
BACKGROUND: We reviewed the updated literature and performed a meta-analysis based on randomized controlled trials in children to compare the clinical efficacy between video laryngoscopes (VLs) and direct laryngoscopes (DLs). METHODS: We searched articles published in English matching the key words 'video laryngoscope (including Airtraq, GlideScope, Storz, TruView, AWS, Bullard, McGrath)' AND 'direct laryngoscope' AND 'children (including pediatric, infant, neonate)' in PubMed, Ovid, Google Scholar, and the Cochrane Library databases...
October 2014: Paediatric Anaesthesia
Jonathan J Gamble, William P McKay, Andrew F Wang, Kinsha A Yip, Jennifer M O'Brien, Christopher E Plewes
BACKGROUND: Accurate endotracheal tube (ETT) depth is critical, especially in children. The current tools used to guide appropriate ETT depth have significant limitations. OBJECTIVES: To evaluate the utility of tracheal palpation in the neck to guide appropriate ETT placement in children. METHODS: A prospective observational study with a convenience sample of 50 children was conducted. During intubation, an investigator palpated the trachea with three fingertips side-by-side extending upward from the suprasternal notch...
October 2014: Paediatric Anaesthesia
Jeff Harless, Ramesh Ramaiah, Sanjay M Bhananker
Securing an airway is a vital task for the anesthesiologist. The pediatric patients have significant anatomical and physiological differences compared with adults, which impact on the techniques and tools that the anesthesiologist might choose to provide safe and effective control of the airway. Furthermore, there are a number of pathological processes, typically seen in the pediatric population, which present unique anatomical or functional difficulties in airway management. The presence of one of these syndromes or conditions can predict a "difficult airway...
January 2014: International Journal of Critical Illness and Injury Science
Sara Mayfield, Jacqueline Jauncey-Cooke, Judith L Hough, Andreas Schibler, Kristen Gibbons, Fiona Bogossian
BACKGROUND: Respiratory support is a central component of the management of critically ill children. It can be delivered invasively via an endotracheal tube or non-invasively via face mask, nasal mask, nasal cannula or oxygen hood/tent. Invasive ventilation can be damaging to the lungs, and the tendency to use non-invasive forms is growing. However, non-invasive delivery is often poorly tolerated by children. High-flow nasal cannula (HFNC) oxygen delivery is a relatively new therapy that shows the potential to reduce the need for intubation and be better tolerated by children than other non-invasive forms of support...
March 7, 2014: Cochrane Database of Systematic Reviews
Jannet J Lee-Jayaram, Loren G Yamamoto
Securing the pediatric airway in the emergency setting is an uncommon event that is complicated by anatomic, physiologic, and environmental factors. Even more uncommonly, practitioners are faced with the added complication of a difficult airway, and the question of what alternatives to traditional endotracheal intubation are available and most useful may arise. Timely and effective intervention determines the patient's clinical outcome. The purpose of this review was to detail specific alternative airway management strategies and tools for use in the pediatric emergency department...
March 2014: Pediatric Emergency Care
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