We analysed data from the Paediatric Difficult Intubation Registry examining the use of direct laryngoscopy and GlideScope ® videolaryngoscopy.
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.
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).
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.
To read this article in full you will need to make a payment
- Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts.Anesth Analg. 2004; 99 (table of contents): 607-613
- Mortality related to anaesthesia in France: analysis of deaths related to airway complications.Anaesthesia. 2009; 64: 366-370
- Management of the difficult airway: a closed claims analysis.Anesthesiology. 2005; 103: 33-39
- Fourth National Audit P. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia.Br J Anaesth. 2011; 106: 617-631
- Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis.Lancet Respir Med. 2016; 4: 37-48
- Trend and outcomes of video laryngoscope use across PICUs.Pediatr Crit Care Med. 2017; 18: 741-749
- Expected difficult tracheal intubation: a prospective comparison of direct laryngoscopy and video laryngoscopy in 200 patients.Br J Anaesth. 2009; 102: 546-550
- Video laryngoscopy improves intubation success and reduces esophageal intubations compared to direct laryngoscopy in the medical intensive care unit.Crit Care. 2013; 17: R237
- Comparative effectiveness of the C-MAC video laryngoscope versus direct laryngoscopy in the setting of the predicted difficult airway.Anesthesiology. 2012; 116: 629-636
- Routine clinical practice effectiveness of the Glidescope in difficult airway management: an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions.Anesthesiology. 2011; 114: 34-41
- Success of intubation rescue techniques after failed direct laryngoscopy in adults: a retrospective comparative analysis from the multicenter perioperative outcomes group.Anesthesiology. 2016; 125: 656-666
- A comparison between the GlideScope Video Laryngoscope and direct laryngoscope in paediatric patients with difficult airways—a pilot study.Anaesthesia. 2010; 65: 353-357
- GlideScope video laryngoscope: a randomized clinical trial in 203 paediatric patients.Br J Anaesth. 2008; 101: 531-534
- Pediatric video laryngoscope versus direct laryngoscope: a meta-analysis of randomized controlled trials.Paediatr Anaesth. 2014; 24: 1056-1065
- Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients.Can J Anaesth. 2005; 52: 191-198
- Comparison of the Cobalt Glidescope video laryngoscope with conventional laryngoscopy in simulated normal and difficult infant airways.Paediatr Anaesth. 2009; 19: 1108-1112
- A randomized comparison of the GlideScope videolaryngoscope to the standard laryngoscopy for intubation by pediatric residents in simulated easy and difficult infant airway scenarios.Pediatr Emerg Care. 2011; 27: 398-402
- Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (excluding neonates).Cochrane Database Syst Rev. 2017; 5 (CD011413)
- A comparative trial of the GlideScope(R) video laryngoscope to direct laryngoscope in children with difficult direct laryngoscopy and an evaluation of the effect of blade size.Anesth Analg. 2013; 117: 176-181
- Children with challenging airways: What about GlideScope(R) video-laryngoscopy?.Anaesth Crit Care Pain Med. 2016; (Advance Access published on December 19)
- Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates.Cochrane Database Syst Rev. 2015; 2 (CD009975)
- Videolaryngoscopy versus fiber-optic intubation through a supraglottic airway in children with a difficult airway: an analysis from the multicenter pediatric difficult intubation registry.Anesthesiology. 2017; 127: 432-440
- Difficult tracheal intubation in obstetrics.Anaesthesia. 1984; 39: 1105-1111
- Incidence and associated factors of difficult tracheal intubations in pediatric ICUs: a report from National Emergency Airway Registry for Children: NEAR4KIDS.Intensive Care Med. 2014; 40: 1659-1669
- A National Emergency Airway Registry for children: landscape of tracheal intubation in 15 PICUs.Crit Care Med. 2013; 41: 874-885
- Sample size determination based on Fisher's Exact Test for use in 2 × 2 comparative trials with low event rates.Control Clin Trials. 1992; 13: 134-147
- The complexities of tracheal intubation with direct laryngoscopy and alternative intubation devices.Ann Emerg Med. 2011; 57: 240-247
- Anterior tonsillar pillar perforation during GlideScope video laryngoscopy.Anesth Analg. 2007; 104 (discussion 1): 1610-1611
- The video laryngoscopes blind spots and possible lingual nerve injury by the Gliderite rigid stylet–case presentation and review of literature.Middle East J Anaesthesiol. 2010; 20: 857-860
- Perforation of the soft palate using the GlideScope videolaryngoscope.Can J Anaesth. 2007; 54: 588-589
- Palatopharyngeal wall perforation during Glidescope intubation.Anaesth Intensive Care. 2008; 36: 870-874
- Videolaryngoscopes in pediatric anesthesia: what's new?.Minerva Anestesiol. 2014; 80: 76-82
Accepted: August 28, 2017
© 2017 The Author(s). Published by Elsevier Inc. All rights reserved.