Stein Mary Lyn, Nagle Julia Heunis, Templeton T Wesley, Staffa Steven J, Flynn Stephen G, Bordini Martina, Nykiel-Bailey Sydney, Garcia-Marcinkiewicz Annery G, Padiyath Febina, Matuszczak Maria, Lee Angela C, Peyton James M, Park Raymond S, von Ungern-Sternberg Britta S, Olomu Patrick N, Hunyady Agnes I, Matava Clyde, Fiadjoe John E, Kovatsis Pete G
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
Anaesthesia. 2025 Jun;80(6):625-635. doi: 10.1111/anae.16576. Epub 2025 Mar 20.
Flexible bronchoscopy is the gold standard for difficult airway management. Clinicians are using videolaryngoscopy increasingly because it is perceived to be easier to use with high success rates. We conducted this study to compare the success rates of the two techniques when used after failed direct laryngoscopy in children with difficult tracheal intubations.
We identified cases where initial attempts at direct laryngoscopy failed in the multicentre Pediatric Difficult Intubation Registry from August 2012-September 2023. After propensity score matching, we compared success rates and complications when videolaryngoscopy and flexible bronchoscopy were used as rescue techniques in the matched cohort and in matched patients weighing < 5 kg.
Clinicians chose videolaryngoscopy more frequently than flexible bronchoscopy when direct laryngoscopy failed (64.7%, 1426/2281 vs. 7.3%, 156/2281, p < 0.001). Propensity score matched cohorts did not differ with respect to first-attempt success, eventual success and complications. For the subgroup of infants < 5 kg, clinicians chose videolaryngoscopy more frequently than flexible bronchoscopy to rescue failed direct laryngoscopy (54.3%, 295/543 vs. 8.9%, 44/543, p < 0.001). First-attempt success was 43% (62/145) with videolaryngoscopy and 62% (18/29) with flexible bronchoscopy (odds ratio 2.19, 95%CI 0.96-4.98, p = 0.061). Eventual success was 71% (103/145) with videolaryngoscopy and 90% (26/29) with flexible bronchoscopy (odds ratio 3.53, 95%CI 1.03-12.2, p = 0.046). Complications did not differ between the techniques.
Videolaryngoscopy was chosen more frequently than flexible bronchoscopy as a rescue technique in a cohort of children with difficult direct laryngoscopy, with similar success and complication rates. For small infants, flexible bronchoscopy had a higher eventual success rate, underscoring the importance of maintaining proficiency with flexible bronchoscopy.
可弯曲支气管镜检查是困难气道管理的金标准。临床医生越来越多地使用视频喉镜，因为它被认为更容易操作且成功率高。我们进行这项研究是为了比较在小儿气管插管困难的直接喉镜检查失败后使用这两种技术的成功率。
我们从2012年8月至2023年9月的多中心小儿困难插管登记处中确定了直接喉镜检查初次尝试失败的病例。在倾向评分匹配后，我们比较了在匹配队列和体重<5 kg的匹配患者中使用视频喉镜和可弯曲支气管镜作为挽救技术时的成功率和并发症。
当直接喉镜检查失败时，临床医生更频繁地选择视频喉镜而非可弯曲支气管镜（64.7%，1426/2281对7.3%，156/2281，p<0.001）。倾向评分匹配队列在首次尝试成功率、最终成功率和并发症方面没有差异。对于体重<5 kg的婴儿亚组，临床医生在挽救直接喉镜检查失败时更频繁地选择视频喉镜而非可弯曲支气管镜（54.3%，295/543对8.9%，44/543，p<0.001）。视频喉镜的首次尝试成功率为43%（62/145），可弯曲支气管镜为62%（18/29）（优势比2.19，95%CI 0.96 - 4.98，p = 0.061）。视频喉镜的最终成功率为71%（103/145），可弯曲支气管镜为90%（26/29）（优势比3.53，95%CI 1.03 - 12.2，p = 0.046）。两种技术的并发症没有差异。
在一组直接喉镜检查困难的儿童中，视频喉镜作为挽救技术的选择比可弯曲支气管镜更频繁，成功率和并发症发生率相似。对于小婴儿，可弯曲支气管镜的最终成功率更高，这突出了保持可弯曲支气管镜操作熟练程度的重要性。
