January 13, 2016
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Increased failure, complication rate associated with two or more tracheal intubations in pediatric patients

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Pediatric patients who underwent two or more tracheal intubations experienced a high failure rate and an increased risk for complications, according to recent research published in The Lancet.

“[W]e have learned that attempting more than two tracheal intubations in children with difficult tracheal intubation is associated with a high failure rate and increased incidence of complications,” John Edem Fiadjoe, MD, from the Children’s Hospital of Philadelphia, and colleagues wrote.

Fiadjoe and colleagues analyzed 1,018 difficult tracheal intubation encounters in pediatric patients between August 2012 and January 2015 recorded in the Pediatric Difficult Intubation (PeDI) registry, according to the abstract. The techniques used in these encounters included direct laryngoscopy (46%), fiber optic bronchoscopy (28%) and indirect video laryngoscopy (18%).

The researchers found that first attempts at intubation with indirect video laryngoscopy were successful in 55% (n = 101) of cases, whereas attempts with fiber optic bronchoscopy and direct laryngoscopy were successful in 54% (n = 153) of cases and 3% (n = 30) of cases, respectively. The intubation failed in 2% (n = 19) of cases, according to the abstract.

Two hundred four patients experienced complications, with 3% (n = 30) of patients reporting severe complications and 19% (n = 192) of patients reporting non-severe complications.

“This high complication rate is multifactorial in origin. The patient-level factors include abnormal airway physical examination and lower patient age and weight. Process factors included multiple tracheal intubation attempts and multiple direct laryngoscopy attempts,” Fiadjoe and colleagues wrote. “Additionally, delays in transition from trainee to attending tracheal intubation attempts could have contributed to complications.” – by Jeff Craven

Disclosure: Two researchers report grant funding from the Agency for Healthcare Research Quality and the Laerdal Foundation Center for Excellence.