The efficacy of GlideScope® videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry

  • Author Footnotes
    † Both authors contributed equally to the manuscript and are considered joint first authors.
    R. Park
    Footnotes
    † Both authors contributed equally to the manuscript and are considered joint first authors.
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA

    Department of Anaesthesiology, Harvard Medical School, Boston, MA, USA
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  • Author Footnotes
    † Both authors contributed equally to the manuscript and are considered joint first authors.
    J.M. Peyton
    Correspondence
    Corresponding author
    Footnotes
    † Both authors contributed equally to the manuscript and are considered joint first authors.
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA

    Department of Anaesthesiology, Harvard Medical School, Boston, MA, USA
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  • J.E. Fiadjoe
    Affiliations
    Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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  • A.I. Hunyady
    Affiliations
    Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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  • T. Kimball
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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  • D. Zurakowski
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA

    Department of Anaesthesiology, Harvard Medical School, Boston, MA, USA
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  • Author Footnotes
    ‡ PeDI Collaborative Investigators are listed in Appendix.
    P.G. Kovatsis
    Footnotes
    ‡ PeDI Collaborative Investigators are listed in Appendix.
    Affiliations
    Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA

    Department of Anaesthesiology, Harvard Medical School, Boston, MA, USA
    Search for articles by this author
  • for the PeDI Collaborative Investigators
  • Author Footnotes
    † Both authors contributed equally to the manuscript and are considered joint first authors.
    ‡ PeDI Collaborative Investigators are listed in Appendix.

      Abstract

      Background

      We analysed data from the Paediatric Difficult Intubation Registry examining the use of direct laryngoscopy and GlideScope ® videolaryngoscopy.

      Methods

      Data collected by a multicentre, paediatric difficult intubation registry from 1295 patients were analysed. Rates of success and complications between direct laryngoscopy and GlideScope videolaryngoscopy were analysed.

      Results

      Initial (464/877 = 53% vs 33/828 = 4%, Z-test = 22.2, P < 0.001) and eventual (720/877 = 82% vs. 174/828 = 21%, Z-test = 25.2, P < 0.001) success rates for GlideScope were significantly higher than direct laryngoscopy. Children weighing <10 kg had lower success rates with the GlideScope than the group as a whole. There were no differences in complication rates per attempt between direct laryngoscopy and GlideScope. The direct laryngoscopy group had more complications associated with the greater number of attempts needed to intubate. There were no increased risks of hypoxia or trauma with GlideScope use. Each additional attempt at intubation with either device resulted in a two-fold increase in complications (odds ratio: 2.0, 95% confidence interval: 1.5–2.5, P < 0.001).

      Conclusions

      During difficult tracheal intubation in children, direct laryngoscopy is an overly used technique with a low chance of success. GlideScope use was associated with a higher chance of success with no increased risk of complications. GlideScope use in children with difficult tracheal intubation has a lower success rate than in adults with difficult tracheal intubation. Children weighing less than 10 kilograms had lower success rates with either device. Attempts should be minimized with either device to decrease complications.
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