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Videolaryngoscopy for difficult tracheal intubation in critically ill children

Videolaryngoscopy for difficult tracheal intubation in critically ill children Critically ill children present unique challenges for tracheal intubation during stabilisation. Planning for induction of anaesthesia involves preparation for all potential airway management consequences, including a ‘cannot intubate, cannot oxygenate’ scenario.The Difficult Airway Society (DAS) guidelines for children prescribe a step‐wise approach including direct laryngoscopy (≤ 4 attempts) and suggest the use of a bougie, a straight blade and smaller tracheal tube in difficult cases [1]. However the role of videolaryngoscopy is not clearly defined. The availability and expertise in the use of videolaryngoscopy has improved globally and there are a range of paediatric size blades available now.Limiting direct laryngoscopy (≤ 2 attempts) and quickly transitioning to an indirect technique such as videolaryngoscopy would enhance patient safety [2]. A recent editorial goes one step further stating that regardless of clinical specialty or patient location to ‘make the first attempt at tracheal intubation your best attempt’ [3] using all available aids.Delays during tracheal intubation and multiple attempts are associated with increased complications in 20% and cardiac arrest in 2% of children presenting with difficult airway [2]. In addition, there is a lag in response time to capnography, and auscultation can be challenging if lung compliance is poor. Hence, the use of early videolaryngoscopy provides maximum opportunity for successful tracheal intubation and allows visual confirmation by more than one individual.The DAS guidelines for critically ill adults recommends videolaryngoscopy and preparation for front‐of‐neck airway after the first failed attempt at tracheal intubation [4]. Clinicians should consider a videolaryngoscope early in critically ill children similar to the adult algorithm.AcknowledgementsNo external funding or competing interests declared.ReferencesAPAGBI Paediatric Airway Guidelines. https://das.uk.com/guidelines/paediatric-difficult-airway-guidelines (accessed 21 May 2020)Jagannathan N, Sohn L, Fiadjoe JE. Paediatric difficult airway management: what every anaesthetist should know!. British Journal of Anaesthesia 2016; 117: i3–i5.Kelly FE, Duggan LV. Preparing for, and more importantly preventing, ‘cannot intubate, cannot oxygenate’ events. Anaesthesia 2020; 75: 707–10.Higgs A, McGrath BA, Goaddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. British Journal of Anaesthesia 2018; 120: 323–52. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anaesthesia Reports Wiley

Videolaryngoscopy for difficult tracheal intubation in critically ill children

Manickam, B. P.
Anaesthesia Reports , Volume 8 (2) – Jul 1, 2020
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Publisher
Wiley
Copyright
2020 © Association of Anaesthetists
eISSN
2637-3726
DOI
10.1002/anr3.12058
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Abstract

Critically ill children present unique challenges for tracheal intubation during stabilisation. Planning for induction of anaesthesia involves preparation for all potential airway management consequences, including a ‘cannot intubate, cannot oxygenate’ scenario.The Difficult Airway Society (DAS) guidelines for children prescribe a step‐wise approach including direct laryngoscopy (≤ 4 attempts) and suggest the use of a bougie, a straight blade and smaller tracheal tube in difficult cases [1]. However the role of videolaryngoscopy is not clearly defined. The availability and expertise in the use of videolaryngoscopy has improved globally and there are a range of paediatric size blades available now.Limiting direct laryngoscopy (≤ 2 attempts) and quickly transitioning to an indirect technique such as videolaryngoscopy would enhance patient safety [2]. A recent editorial goes one step further stating that regardless of clinical specialty or patient location to ‘make the first attempt at tracheal intubation your best attempt’ [3] using all available aids.Delays during tracheal intubation and multiple attempts are associated with increased complications in 20% and cardiac arrest in 2% of children presenting with difficult airway [2]. In addition, there is a lag in response time to capnography, and auscultation can be challenging if lung compliance is poor. Hence, the use of early videolaryngoscopy provides maximum opportunity for successful tracheal intubation and allows visual confirmation by more than one individual.The DAS guidelines for critically ill adults recommends videolaryngoscopy and preparation for front‐of‐neck airway after the first failed attempt at tracheal intubation [4]. Clinicians should consider a videolaryngoscope early in critically ill children similar to the adult algorithm.AcknowledgementsNo external funding or competing interests declared.ReferencesAPAGBI Paediatric Airway Guidelines. https://das.uk.com/guidelines/paediatric-difficult-airway-guidelines (accessed 21 May 2020)Jagannathan N, Sohn L, Fiadjoe JE. Paediatric difficult airway management: what every anaesthetist should know!. British Journal of Anaesthesia 2016; 117: i3–i5.Kelly FE, Duggan LV. Preparing for, and more importantly preventing, ‘cannot intubate, cannot oxygenate’ events. Anaesthesia 2020; 75: 707–10.Higgs A, McGrath BA, Goaddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. British Journal of Anaesthesia 2018; 120: 323–52.

Journal

Anaesthesia Reports – Wiley

Published: Jul 1, 2020

References

  • Paediatric difficult airway management: what every anaesthetist should know!
    Jagannathan, N; Sohn, L; Fiadjoe, JE
  • Preparing for, and more importantly preventing, ‘cannot intubate, cannot oxygenate’ events
    Kelly, FE; Duggan, LV
  • Guidelines for the management of tracheal intubation in critically ill adults
    Higgs, A; McGrath, BA; Goaddard, C