Lin Helen, Lyons Craig, Ong Kar-Binh, Lin Richard
Critical Care Unit, Anaesthetics Department, The Royal Marsden NHS Foundation Trust, London, UK.
Department of Anaesthesia, Great Ormond Street Hospital for Children, London, UK.
Anaesthesia. 2025 Sep;80(9):1057-1064. doi: 10.1111/anae.16624. Epub 2025 May 22.
Children with difficult airways are at high risk of complications. Alternative techniques to direct laryngoscopy for tracheal intubation include videolaryngoscopy, flexible bronchoscopy and the hybrid technique of simultaneous videolaryngoscopy and flexible bronchoscopy. This analysis aimed to compare the first-attempt success of each technique and assess the complications associated with difficult paediatric intubations in a quaternary paediatric institution.
The electronic health records of a single quaternary paediatric hospital were searched to identify anaesthesia encounters involving difficult paediatric intubation. This was defined either by the Pediatric Difficult Intubation Registry criteria or as tracheal intubation requiring ≥ 3 attempts. Primary outcomes were the first-attempt success rate and incidence of complications with each tracheal intubation technique.
From April 2019 to January 2024, 559 encounters involving difficult tracheal intubation were identified. First-attempt success was highest for the hybrid technique (70/94, 74.5%) compared with videolaryngoscopy (143/235, 60.9%, p = 0.020) or direct laryngoscopy (19/190, 10.0%, p < 0.001). The hybrid technique was used to rescue 19/27 (70.4%) encounters where videolaryngoscopy alone was unsuccessful and was successful in all these encounters. Eighty-six (15.4%) encounters had at least one complication. The complication rate was significantly higher for patients weighing < 10 kg (45/184, 24.5%) compared with those weighing ≥ 10 kg (41/375, 10.9%, p < 0.001). The hybrid technique was associated with a lower incidence of complications (5/94, 5.3%) compared with videolaryngoscopy (33/235, 14.0%, p = 0.025) or direct laryngoscopy (41/190, 21.6%, p < 0.001).
In children with difficult tracheal intubation, the hybrid technique was associated with a higher first-attempt success rate compared with videolaryngoscopy alone or direct laryngoscopy. Consideration should be given to the hybrid technique as a first-line approach when difficult tracheal intubation is anticipated and when there is a failed attempt with either direct laryngoscopy or videolaryngoscopy.
气道困难的儿童发生并发症的风险很高。除直接喉镜气管插管技术外，其他技术包括视频喉镜、可弯曲支气管镜以及视频喉镜与可弯曲支气管镜同步使用的混合技术。本分析旨在比较每种技术的首次尝试成功率，并评估在一家四级儿科机构中与困难儿科插管相关的并发症。
检索一家单一的四级儿科医院的电子健康记录，以确定涉及困难儿科插管的麻醉病例。这是根据儿科困难插管登记标准定义的，或者定义为气管插管需要≥3次尝试。主要结局是每种气管插管技术的首次尝试成功率和并发症发生率。
2019年4月至2024年1月，共确定了559例涉及困难气管插管的病例。混合技术的首次尝试成功率最高（70/94，74.5%），高于视频喉镜（143/235，60.9%，p = 0.020）或直接喉镜（19/190，10.0%，p < 0.001）。在27例单独使用视频喉镜未成功的病例中，混合技术成功挽救了19例（70.4%），且在所有这些病例中均取得成功。86例（15.4%）病例至少发生了一种并发症。体重<10kg的患者并发症发生率（45/184，24.5%）显著高于体重≥10kg的患者（41/375，10.9%，p < 0.001）。与视频喉镜（33/235，14.0%，p = 0.025）或直接喉镜（41/190，21.6%，p < 0.001）相比，混合技术的并发症发生率较低（5/94，5.3%）。
在气管插管困难的儿童中，与单独使用视频喉镜或直接喉镜相比，混合技术的首次尝试成功率更高。当预计会出现困难气管插管且直接喉镜或视频喉镜尝试失败时，应考虑将混合技术作为一线方法。
