Clinical Impact of External Laryngeal Manipulation During Laryngoscopy on Tracheal Intubation Success in Critically Ill Children

被引：13

作者：

Kojima, Taiki ^{[1
]}

Laverriere, Elizabeth K. ^{[2
]}

Owen, Erin B. ^{[3
]}

Harwayne-Gidansky, Ilana ^{[4
]}

Shenoi, Asha N. ^{[5
]}

Napolitano, Natalie ^{[6
]}

Rehder, Kyle J. ^{[7
]}

Adu-Darko, Michelle A. ^{[8
]}

Nett, Sholeen T. ^{[9
]}

Spear, Debbie ^{[10
]}

Meyer, Keith ^{[11
]}

Giuliano, John S., Jr. ^{[12
]}

Tarquinio, Keiko M. ^{[13
]}

Sanders, Ronald C., Jr. ^{[14
]}

Lee, Jan Hau ^{[15
]}

Simon, Dennis W. ^{[16
]}

Vanderford, Paula A. ^{[17
]}

Lee, Anthony Y. ^{[18
]}

Brown, Calvin A., III ^{[19
]}

Skippen, Peter W. ^{[20
]}

Breuer, Ryan K. ^{[21
]}

Toedt-Pingel, Iris ^{[22
]}

Parsons, Simon J. ^{[23
]}

Gradidge, Eleanor A. ^{[24
]}

Glater, Lily B. ^{[25
]}

Culver, Kathleen ^{[4
]}

Li, Simon ^{[26
]}

Polikoff, Lee A. ^{[27
]}

Howell, Joy D. ^{[28
]}

Nuthall, Gabrielle ^{[29
]}

Bysani, Gokul K. ^{[30
]}

Graciano, Ana L. ^{[31
]}

Emeriaud, Guillaume ^{[32
]}

Saito, Osamu ^{[33
]}

Orioles, Alberto ^{[34
]}

Walson, Karen ^{[35
]}

Jung, Philipp ^{[36
]}

Al-Subu, Awni M. ^{[37
]}

Ikeyama, Takanari ^{[38
]}

Shetty, Rakshay ^{[39
]}

Yoder, Kathleen M. ^{[5
]}

Nadkarni, Vinay M. ^{[2
]}

Nishisaki, Akira ^{[2
]}

机构：

[1] Childrens Hosp Philadelphia, Ctr Simulat Adv Educ & Innovat, Philadelphia, PA 19104 USA

[2] Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care Med, Philadelphia, PA 19104 USA

[3] Norton Childrens Hosp, Div Crit Care Med, Dept Pediat, Louisville, KY USA

[4] Stony Brook Childrens Hosp, Div Crit Care Med, Dept Pediat, Stony Brook, NY USA

[5] Kentucky Childrens Hosp, Dept Pediat, Div Crit Care Med, Lexington, KY USA

[6] Childrens Hosp Philadelphia, Resp Therapy Dept, Philadelphia, PA 19104 USA

[7] Duke Childrens Hosp, Dept Pediat, Div Crit Care, Durham, NC USA

[8] Univ Virginia, Dept Pediat, Childrens Hosp, Div Crit Care, Charlottesville, VA USA

[9] Dartmouth Hitchcock Med Ctr, Childrens Hosp Dartmouth, Dept Pediat, Div Pediat Crit Care, Lebanon, NH 03766 USA

[10] Penn State Hershey Childrens Hosp, Dept Pediat, Div Pediat Crit Care, Hershey, PA USA

[11] Miami Childrens Hlth Syst, Nicklaus Childrens Hosp, Dept Pediat, Div Crit Care Med, Miami, FL USA

[12] Yale Univ, Sch Med, Dept Pediat, Sect Pediat Crit Care Med, New Haven, CT 06510 USA

[13] Emory Univ, Sch Med, Dept Pediat,Childrens Healthcare Atlanta, Div Pediat Crit Care Med, Atlanta, GA USA

[14] Univ Arkansas Med Sci, Coll Med, Dept Pediat, Sect Crit Care Med,Arkansas Childrens Hosp, Little Rock, AR 72205 USA

[15] KK Womens & Childrens Hosp, Childrens Intens Care, Singapore, Singapore

[16] Univ Pittsburgh, Childrens Hosp Pittsburgh, Med Ctr, Dept Crit Care Med, Pittsburgh, PA 15213 USA

[17] Oregon Hlth & Sci Univ, Dept Pediat, Doernbecher Childrens Hosp, Div Pediat Crit Care Med, 3181 Sw Sam Jackson Pk Rd, Portland, OR 97201 USA

[18] Nationwide Childrens Hosp, Dept Pediat, Div Crit Care, Columbus, OH USA

[19] Brigham & Womens Hosp, Dept Emergency Med, 75 Francis St, Boston, MA 02115 USA

[20] British Columbia Childrens Hosp, Dept Pediat, Intens Care Unit, Vancouver, BC, Canada

[21] SUNY Buffalo, Women & Childrens Hosp Buffalo, Dept Pediat, Div Pediat Crit Care, Buffalo, NY USA

[22] Univ Vermont, Coll Med, Dept Pediat, Div Pediat Crit Care, Burlington, VT USA

[23] Alberta Childrens Prov Gen Hosp, Dept Pediat, Sect Crit Care, Calgary, AB, Canada

[24] Phoenix Childrens Hosp, Dept Pediat, Div Pediat Crit Care Med, Phoenix, AZ USA

[25] Steven & Alexandra Cohen Childrens Med Ctr New Yo, Dept Pediat, Div Pediat Crit Care Med, Hewlett, NY USA

[26] Maria Fareri Childrens Hosp, Dept Pediat, Div Crit Care Med, Valhalla, NY USA

[27] Brown Univ, Dept Pediat, Warren Alpert Sch Med, Div Pediat Crit Care Med, Providence, RI 02912 USA

[28] Cornell Univ, Dept Pediat Crit Care Med, Ithaca, NY USA

[29] Starship Childrens Hosp, Dept Pediat, Pediat Intens Care Unit, Auckland, New Zealand

[30] Med City Childrens Hosp, Dept Pediat Crit Care Med, Dallas, TX USA

[31] Univ Maryland, Childrens Hosp Baltimore, Dept Pediat Crit Care Med, Baltimore, MD 21201 USA

[32] Univ Montreal, St Justine Hosp, Dept Pediat, Montreal, PQ, Canada

[33] Tokyo Metropolitan Childrens Med Ctr, Dept Pediat Emergency & Crit Care Med, Tokyo, Japan

[34] Gillette Childrens Hosp, Dept Pediat, Pediat Intens Care, St Paul, MN USA

[35] Childrens Healthcare Atlanta Scottish Rite, Dept Pediat, Div Pediat Crit Care Med, Atlanta, GA USA

[36] Univ Hosp Schleswig Holstein, Dept Pediat, Campus Luebeck, Lubeck, Germany

[37] Univ Wisconsin, Dept Pediat, Amer Family Childrens Hosp, Div Pediat Crit Care Med, Madison, WI USA

[38] Aichi Childrens Hlth & Med Ctr, Dept Pediat Crit Care Med, Obu, Aichi, Japan

[39] Rainbow Childrens Hosp, Dept Pediat, Div Crit Care, Bangalore, Karnataka, India

来源：

PEDIATRIC CRITICAL CARE MEDICINE | 2018年 / 19卷 / 02期

基金：

美国医疗保健研究与质量局;

关键词：

difficult airway; endotracheal intubation; external laryngeal manipulation; laryngoscopy; pediatric intensive care unit; EMERGENCY AIRWAY REGISTRY; DIFFICULT LARYNGOSCOPY; CRICOID PRESSURE; BIMANUAL LARYNGOSCOPY; PROPENSITY SCORES; PEDIATRIC ICUS; EVENTS; COHORT; PICUS; OUTCOMES;

D O I：

10.1097/PCC.0000000000001373

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives: External laryngeal manipulation is a commonly used maneuver to improve visualization of the glottis during tracheal intubation in children. However, the effectiveness to improve tracheal intubation attempt success rate in the nonanesthesia setting is not clear. The study objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in PICUs. Design: A retrospective observational study using a multicenter emergency airway quality improvement registry. Setting: Thirty-five PICUs within general and children's hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). Patients: Critically ill children (< 18 years) undergoing initial tracheal intubation with direct laryngoscopy in PICUs between July 1, 2010, and December 31, 2015. Measurements and Main Results: Propensity score-matched analysis was performed to evaluate the association between external laryngeal manipulation and initial attempt success while adjusting for underlying differences in patient and clinical care factors: age, obesity, tracheal intubation indications, difficult airway features, provider training level, and neuromuscular blockade use. External laryngeal manipulation was defined as any external force to the neck during laryngoscopy. Of the 7,825 tracheal intubations, the initial tracheal intubation attempt was successful in 1,935/3,274 intubations (59%) with external laryngeal manipulation and 3,086/4,551 (68%) without external laryngeal manipulation (unadjusted odds ratio, 0.69; 95% CI, 0.62-0.75; p < 0.001). In propensity score-matched analysis, external laryngeal manipulation remained associated with lower initial tracheal intubation attempt success (adjusted odds ratio, 0.93; 95% CI, 0.90-0.95; p < 0.001). Conclusions: External laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. The indiscriminate use of external laryngeal manipulation cannot be recommended.

引用

页码：106 / 114

页数：9

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