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Trend and Outcomes of Video Laryngoscope Use Across PICUs.
Pediatr Crit Care Med 2017; 18(8):741-749PC

Abstract

OBJECTIVE

Video (indirect) laryngoscopy is used as a primary tracheal intubation device for difficult airways in emergency departments and in adult ICUs. The use and outcomes of video laryngoscopy compared with direct laryngoscopy has not been quantified in PICUs or cardiac ICUs.

DESIGN

Retrospective review of prospectively collected observational data from a multicenter tracheal intubation database (National Emergency Airway Registry for Children) from July 2010 to June 2015.

SETTING

Thirty-six PICUs/cardiac ICUs across the United States, Canada, Japan, New Zealand, and Singapore.

PATIENTS

Any patient admitted to a PICU or a pediatric cardiac ICU and undergoing tracheal intubation.

INTERVENTIONS

Use of direct laryngoscopy versus video laryngoscopy for tracheal intubation.

MEASUREMENTS AND MAIN RESULTS

There were 8,875 tracheal intubations reported in the National Emergency Airway Registry for Children database, including 7,947 (89.5%) tracheal intubations performed using direct laryngoscopy and 928 (10.5%) tracheal intubations performed using video laryngoscopy. Wide variability in video laryngoscopy use exists across PICUs (median, 2.6%; range, 0-55%). Video laryngoscopy was more often used in older children (p < 0.001), in children with history of a difficult airway (p = 0.01), in children intubated for ventilatory failure (p < 0.001), and to facilitate the completion of an elective procedure (p = 0.048). After adjusting for patient-level covariates, a secular trend, and site-level variance, the use of video laryngoscopy significantly increased over a 5-year period compared with fiscal year 2011 (odds ratio, 6.7; 95% CI, 1.7-26.8 for fiscal year 2014 and odds ratio, 11.2; 95% CI, 3.2-38.9 for fiscal year 2015). The use of video laryngoscopy was independently associated with a lower occurrence of tracheal intubation adverse events (adjusted odds ratio, 0.57; 95% CI, 0.42-0.77; p < 0.001) but not with a lower occurrence of severe tracheal intubation adverse events (adjusted odds ratio, 0.86; 95% CI, 0.56-1.32; p = 0.49) or fewer multiple attempts at endotracheal intubation (adjusted odds ratio, 0.93; 95% CI, 0.71-1.22; p = 0.59).

CONCLUSIONS

Using National Emergency Airway Registry for Children data, we described patient-centered adverse outcomes associated with video laryngoscopy compared with direct laryngoscopy for tracheal intubation in the largest reported international cohort of children to date. Data from this study may be used to design sufficiently powered prospective studies comparing patient-centered outcomes for video laryngoscopy versus direct laryngoscopy during endotracheal intubation.

Authors+Show Affiliations

1Division of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta at Egleston, Emory University School of Medicine, Atlanta, GA. 2Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY. 3Division of Critical Care Medicine, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky School of Medicine, Lexington, KY. 4Division of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA. 5Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Pittsburgh, Pittsburgh, PA. 6Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine, Hershey, PA. 7Division of Critical Care Medicine, Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, NY. 8Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore. 9Division of Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ. 10Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 11Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28492404

Citation

Grunwell, Jocelyn R., et al. "Trend and Outcomes of Video Laryngoscope Use Across PICUs." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 18, no. 8, 2017, pp. 741-749.
Grunwell JR, Kamat PP, Miksa M, et al. Trend and Outcomes of Video Laryngoscope Use Across PICUs. Pediatr Crit Care Med. 2017;18(8):741-749.
Grunwell, J. R., Kamat, P. P., Miksa, M., Krishna, A., Walson, K., Simon, D., ... Nishisaki, A. (2017). Trend and Outcomes of Video Laryngoscope Use Across PICUs. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 18(8), pp. 741-749. doi:10.1097/PCC.0000000000001175.
Grunwell JR, et al. Trend and Outcomes of Video Laryngoscope Use Across PICUs. Pediatr Crit Care Med. 2017;18(8):741-749. PubMed PMID: 28492404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trend and Outcomes of Video Laryngoscope Use Across PICUs. AU - Grunwell,Jocelyn R, AU - Kamat,Pradip P, AU - Miksa,Michael, AU - Krishna,Ashwin, AU - Walson,Karen, AU - Simon,Dennis, AU - Krawiec,Conrad, AU - Breuer,Ryan, AU - Lee,Jan Hau, AU - Gradidge,Eleanor, AU - Tarquinio,Keiko, AU - Shenoi,Asha, AU - Shults,Justine, AU - Nadkarni,Vinay, AU - Nishisaki,Akira, AU - ,, PY - 2017/5/12/pubmed PY - 2018/4/12/medline PY - 2017/5/12/entrez SP - 741 EP - 749 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 18 IS - 8 N2 - OBJECTIVE: Video (indirect) laryngoscopy is used as a primary tracheal intubation device for difficult airways in emergency departments and in adult ICUs. The use and outcomes of video laryngoscopy compared with direct laryngoscopy has not been quantified in PICUs or cardiac ICUs. DESIGN: Retrospective review of prospectively collected observational data from a multicenter tracheal intubation database (National Emergency Airway Registry for Children) from July 2010 to June 2015. SETTING: Thirty-six PICUs/cardiac ICUs across the United States, Canada, Japan, New Zealand, and Singapore. PATIENTS: Any patient admitted to a PICU or a pediatric cardiac ICU and undergoing tracheal intubation. INTERVENTIONS: Use of direct laryngoscopy versus video laryngoscopy for tracheal intubation. MEASUREMENTS AND MAIN RESULTS: There were 8,875 tracheal intubations reported in the National Emergency Airway Registry for Children database, including 7,947 (89.5%) tracheal intubations performed using direct laryngoscopy and 928 (10.5%) tracheal intubations performed using video laryngoscopy. Wide variability in video laryngoscopy use exists across PICUs (median, 2.6%; range, 0-55%). Video laryngoscopy was more often used in older children (p < 0.001), in children with history of a difficult airway (p = 0.01), in children intubated for ventilatory failure (p < 0.001), and to facilitate the completion of an elective procedure (p = 0.048). After adjusting for patient-level covariates, a secular trend, and site-level variance, the use of video laryngoscopy significantly increased over a 5-year period compared with fiscal year 2011 (odds ratio, 6.7; 95% CI, 1.7-26.8 for fiscal year 2014 and odds ratio, 11.2; 95% CI, 3.2-38.9 for fiscal year 2015). The use of video laryngoscopy was independently associated with a lower occurrence of tracheal intubation adverse events (adjusted odds ratio, 0.57; 95% CI, 0.42-0.77; p < 0.001) but not with a lower occurrence of severe tracheal intubation adverse events (adjusted odds ratio, 0.86; 95% CI, 0.56-1.32; p = 0.49) or fewer multiple attempts at endotracheal intubation (adjusted odds ratio, 0.93; 95% CI, 0.71-1.22; p = 0.59). CONCLUSIONS: Using National Emergency Airway Registry for Children data, we described patient-centered adverse outcomes associated with video laryngoscopy compared with direct laryngoscopy for tracheal intubation in the largest reported international cohort of children to date. Data from this study may be used to design sufficiently powered prospective studies comparing patient-centered outcomes for video laryngoscopy versus direct laryngoscopy during endotracheal intubation. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/28492404/Trend_and_Outcomes_of_Video_Laryngoscope_Use_Across_PICUs_ L2 - http://Insights.ovid.com/pubmed?pmid=28492404 DB - PRIME DP - Unbound Medicine ER -