在气道阻塞或插管困难的儿科患者中进行清醒声门上气道置管:来自国际气道登记处(PeDI)的启示。

Mckenna Longacre,Raymond S Park,Steven J Staffa,Matthew J Rowland,Jonathan Meserve,Charles Lord,T Wesley Templeton,Annery G Garcia-Marcinkiewicz,James M Peyton,John E Fiadjoe,Pete G Kovatsis,Mary Lyn Stein,
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We conducted this study to determine outcomes when supraglottic airways were placed in awake children enrolled in the international Pediatric Difficult Intubation Registry including success of ventilation, success of tracheal intubation, and complications.\r\n\r\nMETHODS\r\nWe reviewed the Pediatric Difficult Intubation Registry to identify all cases of awake supraglottic airway placement before planned tracheal intubation from August 2012 to September 2023 with subsequent review of details of awake supraglottic airway placement in the medical record. We present descriptive statistics of patient demographics, ventilation and intubation outcomes, and complications.\r\n\r\nRESULTS\r\nA supraglottic airway was placed in an awake child in 95 of 8061 (1.2%) cases in the Pediatric Difficult Intubation Registry. Median age was 37 days (range 0-17.6 years) and median weight was 3.7 kg (1.6-46.7 kg). Sixteen (17%) cases were in patients older than 2 years and 7 (7%) were in adolescents. 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引用次数: 0

摘要

背景小型病例系列描述了在气道严重阻塞和插管困难的婴儿中进行清醒声门上气道置管的情况。我们进行了这项研究,以确定国际儿科困难插管登记处登记的清醒患儿置入声门上气道的结果,包括通气成功率、气管插管成功率和并发症。方法我们回顾了儿科困难插管登记处,以确定 2012 年 8 月至 2023 年 9 月期间计划气管插管前的所有清醒声门上气道置入病例,并随后回顾了病历中清醒声门上气道置入的详细信息。结果在儿科疑难插管登记处的 8061 例病例中,有 95 例(1.2%)为清醒儿童置入了声门上气道。中位年龄为 37 天(0-17.6 岁),中位体重为 3.7 千克(1.6-46.7 千克)。其中 16 例(17%)患者年龄超过 2 岁,7 例(7%)患者为青少年。81/95(85%,95% 置信区间 [CI],77%-93%)例患者通过声门上气道实现了充分通气。14/95(15%)的患者通气不足(13 例)或无法通气(1 例)。未报告声门上气道置入并发症。在随后的插管过程中,首次尝试成功率为 35%(33/95),最终成功率为 99%(94/95),1 名患者在尝试气管插管失败后苏醒。首次尝试气管插管时发生缺氧的有 9/95 例(9%)。通过声门上气道充分通气的情况下(4/81,5%),缺氧发生率低于通过声门上气道通气不足或无法通气的情况下(5/14,36%)。结论尽管很少尝试,但在气道困难的儿童中清醒置入声门上气道可实现充分通气,并在不同年龄段的麻醉诱导后提供氧合和通气管道。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Awake Supraglottic Airway Placement in Pediatric Patients for Airway Obstruction or Difficult Intubation: Insights From an International Airway Registry (PeDI).
BACKGROUND Small case series have described awake supraglottic airway placement in infants with significant airway obstruction and difficult intubations. We conducted this study to determine outcomes when supraglottic airways were placed in awake children enrolled in the international Pediatric Difficult Intubation Registry including success of ventilation, success of tracheal intubation, and complications. METHODS We reviewed the Pediatric Difficult Intubation Registry to identify all cases of awake supraglottic airway placement before planned tracheal intubation from August 2012 to September 2023 with subsequent review of details of awake supraglottic airway placement in the medical record. We present descriptive statistics of patient demographics, ventilation and intubation outcomes, and complications. RESULTS A supraglottic airway was placed in an awake child in 95 of 8061 (1.2%) cases in the Pediatric Difficult Intubation Registry. Median age was 37 days (range 0-17.6 years) and median weight was 3.7 kg (1.6-46.7 kg). Sixteen (17%) cases were in patients older than 2 years and 7 (7%) were in adolescents. Adequate ventilation via a supraglottic airway was achieved in 81/95 (85%, 95% confidence interval [CI], 77%-93%) encounters. Inadequate (n = 13) or impossible (n = 1) ventilation occurred in 14/95 (15%). No complications were reported with supraglottic airway placement. For subsequent intubation, there was a 35% (33/95) first-attempt success rate and 99% (94/95) eventual success, with 1 patient awakened after failed attempts at tracheal intubation. Hypoxia occurred during the first intubation attempt in 9/95 (9%) encounters. The incidence of hypoxia was lower in encounters in which ventilation via the supraglottic airway was adequate (4/81, 5%) than in encounters in which ventilation via the supraglottic airway was inadequate or impossible (5/14, 36%). CONCLUSIONS Although infrequently attempted, awake placement of a supraglottic airway in children with difficult airways achieved adequate ventilation and provided a conduit for oxygenation and ventilation after induction of anesthesia across a spectrum of ages.
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