1
|
Mo C, Zhang L, Song Y, Liu W. Safety and effectiveness of endotracheal intubation in critically ill emergency patients with videolaryngoscopy. Medicine (Baltimore) 2023; 102:e35692. [PMID: 37933038 PMCID: PMC10627691 DOI: 10.1097/md.0000000000035692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 09/27/2023] [Indexed: 11/08/2023] Open
Abstract
To investigate the safety and efficacy of video laryngoscopy for endotracheal intubation in critically ill patients. A total of 106 critically ill emergency patients treated at our hospital between January 2021 and June 2022 were randomly divided into 2 groups, the visual and direct groups, with 53 patients in each group. Both groups were treated with endotracheal intubation; the visual group was treated with video laryngoscopy, and the direct group was treated with conventional direct laryngoscopy. The Cormack-Lehane grade, percentage of glottic opening score, success rate of one intubation, intubation time, number of intubation attempts, hemodynamic values, and complications were compared between the 2 groups. The success rates of glottis exposure and one-time intubation were significantly higher while the intubation time and number of intubation attempts significantly lower in the visual group than in the direct group. The heart rate, mean arterial pressure (MAP), or blood oxygen saturation did not differ significantly between the 2 groups 10 minutes after entering the room (T0) or after anesthesia induction (T1). MAP was significantly lower in the visual group than in the direct group during immediate intubation (T2). The heart rate and MAP were significantly lower in the visual group than in the direct group 1 minute (T3) and 5 minutes (T4) after intubation. The incidences of intubation-related complications in the visual and direct groups were 7.55% and 22.60%, showing a significant difference. Endotracheal intubation under videolaryngoscopy is safer and more effective for critically ill emergency patients than conventional direct laryngoscopy. This can improve the success rate of intubation, reduce the intubation time, and reduce its effect on hemodynamics. Therefore, it is worthy of further clinical application.
Collapse
Affiliation(s)
- Chenghang Mo
- Department of Emergency, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Liang Zhang
- Department of Emergency, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yingjiang Song
- Department of Emergency, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Weifeng Liu
- Department of Emergency, The Third Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| |
Collapse
|
2
|
Abstract
'Apnoeic oxygenation' describes the diffusion of oxygen across the alveolar-capillary interface in the absence of tidal respiration. Apnoeic oxygenation requires a patent airway, the diffusion of oxygen to the alveoli, and cardiopulmonary circulation. Apnoeic oxygenation has varied applications in adult medicine including facilitating tubeless anaesthesia or improving oxygenation when a difficult airway is known or anticipated. In the paediatric population, apnoeic oxygenation prolongs the time to oxygen desaturation, facilitating intubation. This application has gained attention in neonatal intensive care where intubation remains a challenging procedure. Difficulties are related to the infant's size and decreased respiratory reserve. In addition, policy changes have led to limited opportunities for operators to gain proficiency. Until recently, evidence of benefit of apnoeic oxygenation in the neonatal population came from a small number of infants recruited to paediatric studies. Evidence specific to neonates is emerging and suggests apnoeic oxygenation may increase intubation success and limit physiological instability during the procedure. The best way to deliver oxygen to facilitate apnoeic oxygenation remains an important question.
Collapse
Affiliation(s)
- Elizabeth K Baker
- Newborn Research Centre, Royal Women's Hospital, Victoria, Australia, Level 7, 20 Flemington Rd, Parkville, Victoria, 3052, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkivlle, Victoria, Australia.
| | - Peter G Davis
- Newborn Research Centre, Royal Women's Hospital, Victoria, Australia, Level 7, 20 Flemington Rd, Parkville, Victoria, 3052, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkivlle, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Kate A Hodgson
- Newborn Research Centre, Royal Women's Hospital, Victoria, Australia, Level 7, 20 Flemington Rd, Parkville, Victoria, 3052, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkivlle, Victoria, Australia.
| |
Collapse
|
3
|
张 晨, 廖 宏, 李 浩, 徐 亚, 张 桂, 王 晓, 鲍 红. [THRIVE combined with i-gel laryngeal mask for prolonging apneic oxygenation time in retrograde intrarenal surgery]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2023; 43:1599-1605. [PMID: 37814875 PMCID: PMC10563095 DOI: 10.12122/j.issn.1673-4254.2023.09.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To explore the effect of THRIVE combined with i-gel laryngeal mask on the safety of oxygen therapy in apnea and surgical precision of retrograde intrarenal surgery. METHODS A total of 120 patients undergoing retrograde intrarenal surgery under general anesthesia with laryngeal mask were randomized into 3 groups (n=40), and after the flexible ureteroscope entered the renal pelvis and located the stones, the patients received assisted ventilation in APPV mode (control group), ventilation with small tidal volume and high respiratory rate (group H), or THRIVE combined with laryngeal mask for oxygen supply without using the ventilator (THRIVE group). The time for lithotripsy by the surgeons, surgeons' satisfaction, diaphragm mobility, and times of urinary tract mucosal injury were recorded, and arterial blood pressure, heart rate, SpO2, PaO2, PaCO2, and pH value were measured before, during and after lithotripsy. RESULTS Among the 3 groups, THRIVE group had the shortest time for lithotripsy, best satisfaction of the surgeons, the lowest diaphragmatic mobility of the patients, and the smallest number of mucosal injuries. The arterial blood pressure, heart rate, and SpO2 of the patients did not differ significantly among the 3 groups. At 20 min and 30 min after the start of lithotripsy, PaO2 decreased significantly in group H and THRIVE group; in THRIVE group, PaCO2 increased and pH decreased significantly at 10, 20 and 30 min after the start of lithotripsy. No significant difference was found in oxygenation indicators among the 3 groups upon discharge from the PACU. CONCLUSION In retrograde intrarenal surgery, THRIVE combined with i- gel laryngeal mask for oxygen therapy during the anaerobic period can improve the surgical accuracy and maintain the patient's oxygenation index in a controllable range within 30 min.
Collapse
Affiliation(s)
- 晨 张
- 南京医科大学附属南京医院(南京市第一医院)麻醉科,江苏 南京 210006Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/ Nanjing First Hospital, Nanjing 210006, China
| | - 宏森 廖
- 南京医科大学附属南京医院(南京市第一医院)麻醉科,江苏 南京 210006Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/ Nanjing First Hospital, Nanjing 210006, China
| | - 浩甲 李
- 南京医科大学附属南京医院(南京市第一医院)麻醉科,江苏 南京 210006Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/ Nanjing First Hospital, Nanjing 210006, China
| | - 亚杰 徐
- 南京医科大学附属南京医院(南京市第一医院)麻醉科,江苏 南京 210006Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/ Nanjing First Hospital, Nanjing 210006, China
| | - 桂 张
- 南京医科大学附属脑科医院麻醉科,江苏 南京 210029Department of Anesthesiology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - 晓亮 王
- 南京医科大学附属南京医院(南京市第一医院)麻醉科,江苏 南京 210006Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/ Nanjing First Hospital, Nanjing 210006, China
| | - 红光 鲍
- 南京医科大学附属南京医院(南京市第一医院)麻醉科,江苏 南京 210006Department of Anesthesiology, Nanjing Hospital Affiliated to Nanjing Medical University/ Nanjing First Hospital, Nanjing 210006, China
| |
Collapse
|
4
|
George S, Gibbons K, Williams T, Humphreys S, Gelbart B, Le Marsney R, Craig S, Tingay D, Chavan A, Schibler A. Transnasal Humidified Rapid Insufflation Ventilatory Exchange in children requiring emergent intubation (Kids THRIVE): a statistical analysis plan for a randomised controlled trial. Trials 2023; 24:369. [PMID: 37259146 DOI: 10.1186/s13063-023-07330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/25/2023] [Indexed: 06/02/2023] Open
Abstract
The placement of an endotracheal tube for children with acute or critical illness is a low-frequency and high-risk procedure, associated with high rates of first-attempt failure and adverse events, including hypoxaemia. To reduce the frequency of these adverse events, the provision of oxygen to the patient during the apnoeic phase of intubation has been proposed as a method to prolong the time available for the operator to insert the endotracheal tube, prior to the onset of hypoxaemia. However, there are limited data from randomised controlled trials to validate the efficacy of this technique in children. The technique known as transnasal humidified rapid insufflation ventilatory exchange (THRIVE) uses high oxygen flow rates (approximately 2 L/kg/min) delivered through nasal cannulae during apnoea. It has been shown to at least double the amount of time available for safe intubation in healthy children undergoing elective surgery. The technique and its application in real time have not previously been studied in acutely ill or injured children presenting to the emergency department or admitted to an intensive care unit. The Kids THRIVE trial is a multicentre, international, randomised controlled trial (RCT) in children less than 16 years old undergoing emergent intubation in either the intensive care unit or emergency department of participating hospitals. Participants will be randomised to receive either the THRIVE intervention or standard care (no apnoeic oxygenation) during their intubation. The primary objective of the trial is to determine if the use of THRIVE reduces the frequency of oxygen desaturation and increases the frequency of first-attempt success without hypoxaemia in emergent intubation of children compared with standard practice. The secondary objectives of the study are to assess the impact of the use of THRIVE on the rate of adverse events, length of mechanical ventilation and length of stay in intensive care. In this paper, we describe the detailed statistical analysis plan as an update of the previously published protocol.
Collapse
Affiliation(s)
- Shane George
- Departments of Emergency Medicine, Children's Critical Care, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, Australia.
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia.
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Australia.
| | - Kristen Gibbons
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Tara Williams
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
- Division of Critical Care Medicine, Queensland Children's Hospital, South Brisbane, Australia
| | - Susan Humphreys
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
- Division of Critical Care Medicine, Queensland Children's Hospital, South Brisbane, Australia
| | - Ben Gelbart
- Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Renate Le Marsney
- Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Simon Craig
- Paediatric Emergency Department, Monash Medical Centre, Monash Emergency Research Collaborative, Monash Health, Clayton, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, VIC, Australia
| | - David Tingay
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Department of Neonatology, The Royal Children's Hospital, Melbourne, VIC, Australia
- Neonatal Research, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Arjun Chavan
- Paediatric Intensive Care Unit, Townsville University Hospital, Townsville, Australia
| | - Andreas Schibler
- St Andrew's War Memorial Hospital, Brisbane, Australia
- Critical Care Research Group, St Andrew's War Memorial Hospital, Brisbane, Australia
- Wesley Medical Research, Auchenflower, Queensland, Australia
| |
Collapse
|
5
|
Napolitano N, Polikoff L, Edwards L, Tarquinio KM, Nett S, Krawiec C, Kirby A, Salfity N, Tellez D, Krahn G, Breuer R, Parsons SJ, Page-Goertz C, Shults J, Nadkarni V, Nishisaki A. Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children. Crit Care 2023; 27:26. [PMID: 36650568 PMCID: PMC9847056 DOI: 10.1186/s13054-023-04304-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI), reduces adverse TI-associated events (TIAEs) in children. METHODS AO was implemented across 14 pediatric intensive care units as a quality improvement intervention during 2016-2020. Implementation consisted of an intubation safety checklist, leadership endorsement, local champion, and data feedback to frontline clinicians. Standardized oxygen flow via nasal cannula for AO was as follows: 5 L/min for infants (< 1 year), 10 L/min for young children (1-7 years), and 15 L/min for older children (≥ 8 years). Outcomes were the occurrence of adverse TIAEs (primary) and hypoxemia (SpO2 < 80%, secondary). RESULTS Of 6549 TIs during the study period, 2554 (39.0%) occurred during the pre-implementation phase and 3995 (61.0%) during post-implementation phase. AO utilization increased from 23 to 68%, p < 0.001. AO was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patient intubated due to respiratory or neurological failure or shock. Conversely, AO was used more often in TIs done for procedures and those assisted by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%, p < 0.001), aOR 0.75 (95% CI 0.58-0.98, p = 0.03) after adjusting for site clustering (primary analysis). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs: aOR 0.90, 95% CI 0.72-1.12, p = 0.33 and the occurrence of hypoxemia was not different: AO 14.2% versus without AO 15.2%, p = 0.43. CONCLUSION While AO use was associated with a lower occurrence of adverse TIAEs in children who required TI in the pediatric ICU after accounting for site-level clustering, this result may be explained by differences in patient, provider, and practice factors. Trial Registration Trial not registered.
Collapse
Affiliation(s)
- Natalie Napolitano
- grid.239552.a0000 0001 0680 8770Respiratory Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Lee Polikoff
- grid.40263.330000 0004 1936 9094Division of Pediatric Critical Care Medicine, The Warren Alpert School of Medicine at Brown University, Providence, RI USA
| | - Lauren Edwards
- grid.266813.80000 0001 0666 4105Division of Critical Care, Department of Pediatrics, Children’s Healthcare of Atlanta, University of Nebraska Medical Center and Children’s Hospital and Medical Center, Omaha, NE USA
| | - Keiko M. Tarquinio
- grid.189967.80000 0001 0941 6502Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA USA
| | - Sholeen Nett
- grid.413480.a0000 0004 0440 749XDivision of Pediatric Critical Care, Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH USA
| | - Conrad Krawiec
- grid.29857.310000 0001 2097 4281Division of Pediatric Critical Care Medicine, Penn State Health Children’s Hospital, Hershey, PA USA
| | - Aileen Kirby
- grid.5288.70000 0000 9758 5690Division of Pediatric Critical Care Medicine, Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, OR USA
| | - Nina Salfity
- grid.417276.10000 0001 0381 0779Department of Critical Care, Phoenix Children’s Hospital, Phoenix, AZ USA
| | - David Tellez
- grid.417276.10000 0001 0381 0779Department of Critical Care, Phoenix Children’s Hospital, Phoenix, AZ USA
| | - Gordon Krahn
- grid.17091.3e0000 0001 2288 9830Division of Pediatric Critical Care, University of British Columbia, Vancouver, BC Canada
| | - Ryan Breuer
- grid.413993.50000 0000 9958 7286Division of Pediatric Critical Care, Oishei Children’s Hospital, Buffalo, NY USA
| | - Simon J. Parsons
- grid.413571.50000 0001 0684 7358Division of Critical Care, Alberta Children’s Hospital, Calgary, Canada
| | - Christopher Page-Goertz
- grid.413473.60000 0000 9013 1194Division of Critical Care Medicine, Akron Children’s Hospital, Akron, OH USA
| | - Justine Shults
- grid.239552.a0000 0001 0680 8770Division of Anesthesia and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Vinay Nadkarni
- grid.239552.a0000 0001 0680 8770Division of Anesthesia and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Akira Nishisaki
- grid.239552.a0000 0001 0680 8770Division of Anesthesia and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | | |
Collapse
|
6
|
George S, Wilson M, Humphreys S, Gibbons K, Long E, Schibler A. Apnoeic oxygenation during paediatric intubation: A systematic review. Front Pediatr 2022; 10:918148. [PMID: 36479287 PMCID: PMC9720125 DOI: 10.3389/fped.2022.918148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/20/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This review assesses the effect of apnoeic oxygenation during paediatric intubation on rates of hypoxaemia, successful intubation on the first attempt and other adverse events. DATA SOURCES The databases searched included PubMed, Medline, CINAHL, EMBASE and The Cochrane Library. An electronic search for unpublished studies was also performed. STUDY SELECTION We screened studies that include children undergoing intubation, studies that evaluate the use of apnoeic oxygenation by any method or device with outcomes of hypoxaemia, intubation outcome and adverse events were eligible for inclusion. DATA EXTRACTION Screening, risk of bias, quality of evidence and data extraction was performed by two independent reviewers, with conflicts resolved by a third reviewer where consensus could not be reached. DATA SYNTHESIS From 362 screened studies, fourteen studies (N = 2442) met the eligibility criteria. Randomised controlled trials (N = 482) and studies performed in the operating theatre (N = 835) favoured the use of apnoeic oxygenation with a reduced incidence of hypoxaemia (RR: 0.34, 95% CI: 0.24 to 0.47, p < 0.001, I 2 = 0% and RR: 0.27, 95% CI: 0.11 to 0.68, p = 0.005, I 2 = 68% respectively). Studies in the ED and PICU were of lower methodological quality, displaying heterogeneity in their results and were unsuitable for meta-analysis. Among the studies reporting first attempt intubation success, there were inconsistent effects reported and data were not suitable for meta-analysis. CONCLUSION There is a growing body of evidence to support the use of apnoeic oxygenation during the intubation of children. Further research is required to determine optimal flow rates and delivery technique. The use of humidified high-flow oxygen shows promise as an effective technique based on data in the operating theatre, however its efficacy has not been shown to be superior to low flow oxygen in either the elective anesthetic or emergency intubation situations Systematic Review Registration: This review was prospectively registered in the PROSPERO international register of systematic reviews (Reference: CRD42020170884, registered April 28, 2020).
Collapse
Affiliation(s)
- Shane George
- Departments of Emergency Medicine and Children's Critical Care, Gold Coast University Hospital, Southport, QLD, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Megan Wilson
- Emergency Department, Tweed Heads Hospital, Tweed Heads, NSW, Australia.,Emergency Department, Lismore Base Hospital, Lismore, NSW, Australia
| | - Susan Humphreys
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.,Department of Anaesthesia, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Kristen Gibbons
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Elliot Long
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia.,Clinical Sciences, Murdoch Children's Research Institute, VIC, Australia.,Department of Critical Care, University of Melbourne, VIC, Australia
| | - Andreas Schibler
- Critical Care Research Group, Intensive Care Unit, St Andrews War Memorial Hospital, Brisbane, QLD, Australia.,Wesley Medical Research, Auchenflower, QLD, Australia
| |
Collapse
|
7
|
George S, Long E, Gelbart B, Dalziel SR, Babl FE, Schibler A. Intubation practices for children in emergency departments and intensive care units across Australia and New Zealand: A survey of medical staff. Emerg Med Australas 2020; 32:1052-1058. [PMID: 32969150 DOI: 10.1111/1742-6723.13620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/28/2020] [Accepted: 08/06/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Intubation of children in the emergency setting is a high-risk, low incidence event. Standardisation of clinical practice has been hampered by a lack of high-quality evidence to support one technique over another. The aim of the present study is to determine clinician preference in intubation practice of children in EDs and ICUs in Australia and New Zealand to provide baseline information to allow future targeted research focused on improving the safety and efficacy of paediatric emergency airway management. METHODS The present study was a voluntary questionnaire undertaken by medical staff at registrar level or above in EDs and ICUs associated with the Paediatric Research in Emergency Departments International Collaborative (PREDICT) and Australia and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG) research networks. Respondents reported on their individual intubation practices, with a focus on pre-oxygenation and apnoeic oxygenation techniques, and the use of video laryngoscopy. RESULTS A total of 502 clinicians were invited to complete the survey between May and October 2018 with 336 (66.9%) responded. There was marked variation in practice between ED clinicians and ICU clinicians in the techniques used for pre-oxygenation, the frequency of use of apnoeic oxygenation and the reported use of video laryngoscopy. CONCLUSIONS Within Australia and New Zealand there is considerable variation in paediatric emergency airway clinical practice, in particular with respect to pre-oxygenation, apnoeic oxygenation and use of video laryngoscopy. Definitive clinical trials are required to best inform clinical practice in this area.
Collapse
Affiliation(s)
- Shane George
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Department of Children's Critical Care, Gold Coast University Hospital, Gold Coast, Queensland, Australia.,Paediatric Critical Care Research Group, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Elliot Long
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ben Gelbart
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Paediatric Intensive Care, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Department of Paediatrics Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Franz E Babl
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Centre for Integrated Critical Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | | |
Collapse
|
8
|
Humphreys S, Schibler A. Nasal high-flow oxygen in pediatric anesthesia and airway management. Paediatr Anaesth 2020; 30:339-346. [PMID: 31833137 DOI: 10.1111/pan.13782] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/06/2019] [Indexed: 11/29/2022]
Abstract
Nasal High-Flow (NHF) is weight-dependent in children, aimed to match peak inspiratory flow and thereby deliver an accurate FiO2 with a splinting pressure of 4-6 cm H2 O. During apnea in children, NHF oxygen can double the expected time to desaturation below 90% in well children but there is no ventilatory exchange; therefore, children do not "THRIVE". Total intravenous anesthesia competency to maintain spontaneous breathing is an important adjunct for successful NHF oxygenation technique during anesthesia. Jaw thrust to maintain a patent upper airway is paramount until surgical instrumentation occurs. There is no evidence to support safe use of NHF oxygen with LASER use due to increased risk of airway fire.
Collapse
Affiliation(s)
- Susan Humphreys
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.,Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.,Paediatric Intensive Care, Queensland Children's Hospital, South Brisbane, QLD, Australia
| |
Collapse
|
9
|
Lauder GR, Thomas M, von Ungern-Sternberg BS, Engelhardt T. Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro-con discussion. Paediatr Anaesth 2020; 30:209-220. [PMID: 31886922 DOI: 10.1111/pan.13809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 12/21/2022]
Abstract
Anesthesia for pediatric airway procedures constitutes a true art form that requires training and experience. Communication between anesthetist and surgeon to establish procedure goals is essential in determining the most appropriate anesthetic management. But does the mode of anesthesia have an impact? Traditionally, inhalational anesthesia was the most common anesthesia technique used during airway surgery. Introduction of agents used for total intravenous anesthesia (TIVA) such as propofol, short-acting opioids, midazolam, and dexmedetomidine has driven change in practice. Ongoing debates abound as to the advantages and disadvantages of volatile-based anesthesia versus TIVA. This pro-con discussion examines both volatiles and TIVA, from the perspective of effectiveness, safety, cost, and environmental impact, in an endeavor to justify which technique is the best specifically for pediatric airway procedures.
Collapse
Affiliation(s)
- Gillian R Lauder
- Department of Anesthesia, BC Children's Hospital, Vancouver, Canada.,Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
| | - Mark Thomas
- Department of Anaesthesia, Great Ormond St Hospital, London, UK
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| | - Thomas Engelhardt
- Department of Anesthesia, McGill University Health Centre, Montreal Children's Hospital, Montreal, QC, Canada
| |
Collapse
|
10
|
Liang H, Hou Y, Sun L, Li Q, Wei H, Feng Y. Supraglottic jet oxygenation and ventilation for obese patients under intravenous anesthesia during hysteroscopy: a randomized controlled clinical trial. BMC Anesthesiol 2019; 19:151. [PMID: 31409366 PMCID: PMC6693218 DOI: 10.1186/s12871-019-0821-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/06/2019] [Indexed: 12/14/2022] Open
Abstract
Background Supraglottic jet oxygenation and ventilation (SJOV) can effectively maintain adequate oxygenation in patients with respiratory depression, even in apnea patients. However, there have been no randomized controlled clinical trials of SJOV in obese patients. This study investigated the efficacy and safety of SJOV using WEI Nasal Jet tube (WNJ) for obese patients who underwent hysteroscopy under intravenous anesthesia without endotracheal intubation. Methods A single-center, prospective, randomized controlled study was conducted. The obese patients receiving hysteroscopy under intravenous anesthesia were randomly divided into three groups: Control group maintaining oxygen supply via face masks (100% oxygen, flow at 6 L/min), the WNJ Oxygen Group with WNJ (100% oxygen, flow: 6 L/min) and the WNJ SJOV Group with SJOV via WNJ [Jet ventilator working parameters:100% oxygen supply, driving pressure (DP) 0.1 MPa, respiratory rate; (RR): 15 bpm, I/E; ratio 1:1.5]. SpO2, PETCO2, BP, HR, ECG and BIS were continuously monitored during anesthesia. Two-Diameter Method was deployed to measure cross sectional area of the gastric antrum (CSA-GA) by ultrasound before and after SJOV in the WNJ SJOV Group. Episodes of SpO2 less than 95%, PETCO2 less than 10 mmHg, depth of WNJ placement and measured CSA-GA before and after jet ventilation in the WNJ SJOV Group during the operation were recorded. The other adverse events were collected as well. Results A total of 102 patients were enrolled, with two patients excluded. Demographic characteristics were similar among the three groups. Compared with the Control Group, the incidence of PETCO2 < 10 mmHg, SpO2 < 95% in the WNJ SJOV group dropped from 36 to 9% (P = 0.009),from 33 to 6% (P = 0.006) respectively,and the application rate of jaw-lift decreased from 33 to 3% (P = 0.001), and the total percentage of adverse events decreased from 36 to 12% (P = 0.004). Compared with the WNJ Oxygen Group, the use of SJOV via WNJ significantly decreased episodes of SpO2 < 95% from 27 to 6% (P = 0.023), PETCO2 < 10 mmHg from 33 to 9% (P = 0.017), respectively. Depth of WNJ placement was about 12.34 cm in WNJ SJOV Group. There was no significantly difference of CSA-GA before and after SJOV in the WNJ SJOV Group (P = 0.234). There were no obvious cases of nasal bleeding in all the three groups. Conclusions SJOV can effectively and safely maintain adequate oxygenation in obese patients under intravenous anesthesia without intubation during hysteroscopy. This efficient oxygenation may be mainly attributed to supplies of high concentration oxygenation to the supraglottic area, and the high pressure jet pulse providing effective ventilation. Although the nasal airway tube supporting collapsed airway by WNJ also plays a role. SJOV doesn’t seem to increase gastric distension and the risk of aspiration. SJOV can improve the safety of surgery by reducing the incidence of the intraoperative involuntary limbs swing, hip twist and cough. Trial registration Chinese Clinical Trial Registry. Registration number, ChiCTR1800017028, registered on July 9, 2018.
Collapse
Affiliation(s)
- Hansheng Liang
- Department of Anesthesiology, Peking University People's Hospital, Beijing100044, Beijing, China
| | - Yuantao Hou
- Department of Anesthesiology, Peking University People's Hospital, Beijing100044, Beijing, China
| | - Liang Sun
- Department of Anesthesiology, Peking University People's Hospital, Beijing100044, Beijing, China
| | - Qingyue Li
- Department of Anesthesiology, Peking University People's Hospital, Beijing100044, Beijing, China
| | - Huafeng Wei
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, Beijing100044, Beijing, China.
| |
Collapse
|