1. Morbidity and Mortality in Patients with Difficult Tracheal Intubation: An Analysis of the PeDIR Registry
Vikram Patel MD, Madnankumar Sathyamoorthy MBBS MS,John Fiadjoe MD PeDI Collaborative Investigators,
Thomas Austin MD, Samia Khalil MD
METHODS
RESULTSINTRODUCTION FIGURES
CONCLUSION
•Adverse events in children with difficult conventional laryngoscopy
are unknown.
•PeDIR is a multicenter database of 14 tertiary care pediatric
institutions contributing practice data relating to difficult direct
laryngoscopy (DDL) events in children (birth to 18 years of age). We
reviewed accumulated cases from August 2012 to November 2014.
•DDL was defined by one of the following four criteria:
1.DL by faculty fails to visualize any part of the vocal cords
2.DL was impossible due to physical limitations (mouth opening etc.)
3.DL has failed within a 6 month period
4.DL is deferred because of potential harm in a patient suspected be a
challenging conventional laryngoscopy.
•The following were defined as severe complications: 1. Pneumothorax;
2. Severe airway trauma; 3. Aspiration; 4. Cardiac arrest; 5. Death; and 6.
Delayed recognition of esophageal intubation.
•Other Complications analyzed included: 1. Minor airway trauma; 2.
Arrhythmia; 3. Bronchospasm; 4. Epistaxis; 5. Hypoxia; 6. Laryngospasm;
7. Immediate recognition of esophageal intubation.
•Univariate and Multivariate analyses were performed in order to
determine risk factors that were associated with both severe and other
complications due to difficult tracheal intubation.
•900 cases were analyzed.
•Overall complication rate was 22.7% with a severe rate of 2.6%.
• Using univariate analysis, patients that had severe complications
weighed less (15.3kg vs. 24.2kg, P = 0.016), had airway management outside
of the operating room (7.9% vs. 2.0%, P = 0.005), had more unanticipated
difficult airways (5.5% vs. 1.7%, P = 0.009), and required more intubation
attempts (4 vs. 2, P < 0.0001) than patients that did not have severe
complications.
•These results were similar on multivariate analysis (Table 1) with the
exception of weight.
• There is significant morbidity and mortality in pediatric patients with
difficult direct laryngoscopy.
•Multiple intubation attempts, intubation outside of the operating room,
and unknown difficult airways were all associated with severe complications
in this cohort.
TABLES
PURPOSE
•To evaluate the characteristics associated with complications in
pediatric patients with difficult intubation using the multicenter Pediatric
Difficult Intubation registry (PeDIR).
DEPARTMENT OF ANESTHESIOLOGY