Department of Paediatric Anaesthesia, Royal Aberdeen Children's Hospital and University of Aberdeen, Aberdeen, UK.
Bolyai Institute, University of Szeged, Szeged, Hungary.
Br J Anaesth. 2018 Jul;121(1):66-75. doi: 10.1016/j.bja.2018.04.013. Epub 2018 May 18.
Critical respiratory events are common in children in the peri-anaesthetic period and are caused by airway and ventilation management difficulties. We aimed to analyse current European paediatric airway management practices and identify the incidence and potential consequences of difficult airway management.
We performed a secondary analysis of airway and ventilation management details of the European multicentre observational trial (Anaesthesia PRactice in Children Observational Trial, APRICOT) of children from birth to 15 yr of age. The primary endpoint was the incidence of difficult airway management. Secondary endpoints were the associations between difficult airway management, known pre-existing respiratory risk factors, and the occurrence of critical respiratory events.
Details for 31 024 anaesthetic procedures were available for analysis. Three or more tracheal intubation attempts were necessary in 120 children (0.9%) and in 40 children (0.4%) for supraglottic airways insertions. The incidence (95% confidence interval) for failed tracheal intubation and failed supraglottic airway insertions was 8/10 000 (0.08%; 0.03-0.13%) and 8.2/10 000 (0.08%; 0.03-0.14%) children, respectively. Difficulties in securing the airway increased the risk for a critical respiratory event for tracheal tube (2.1; 1.3-3.4) and supraglottic airway (4.3; 1.9-9.9) placement. History of pre-existing respiratory risk factors was significantly associated with critical respiratory events independently of the airway device used.
Airway management practices vary widely across Europe. Multiple airway device insertion attempts and pre-existing respiratory risk factors increase the likelihood of critical respiratory events in children and require further stratification during preoperative assessment and planning. This study highlights areas where education, research, and training may improve perioperative care.
NCT01878760.
围麻醉期儿童常见危急呼吸事件，其病因是气道和通气管理困难。我们旨在分析当前欧洲儿科气道管理实践，并确定困难气道管理的发生率和潜在后果。
我们对出生至 15 岁儿童的欧洲多中心观察性试验（小儿麻醉实践观察试验，APRICOT）的气道和通气管理细节进行了二次分析。主要终点是困难气道管理的发生率。次要终点是困难气道管理与已知的预先存在的呼吸风险因素之间的关联，以及危急呼吸事件的发生。
共 31 024 例麻醉过程的详细资料可用于分析。120 名儿童（0.9%）和 40 名儿童（0.4%）需要进行 3 次或更多次气管插管尝试。气管插管失败和失败的supraglottic 气道插入的发生率（95%置信区间）分别为 8/10 000（0.08%；0.03-0.13%）和 8.2/10 000（0.08%；0.03-0.14%）儿童。气道安全保障困难增加了气管导管（2.1；1.3-3.4）和 supraglottic 气道（4.3；1.9-9.9）放置的危急呼吸事件风险。预先存在的呼吸风险因素的病史与危急呼吸事件显著相关，独立于使用的气道设备。
欧洲各地的气道管理实践差异很大。多次气道设备插入尝试和预先存在的呼吸风险因素增加了儿童发生危急呼吸事件的可能性，在术前评估和计划中需要进一步分层。本研究强调了教育、研究和培训可能改善围手术期护理的领域。
NCT01878760。
