Pediatric anesthesia & critical care
Combined videolaryngoscopy and flexible bronchoscopy for difficult tracheal intubation in children: a retrospective observational cohort study
Authors' conclusion
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.
Study context
- Population
- Anaesthesia encounters involving difficult paediatric tracheal intubation (Pediatric Difficult Intubation Registry criteria or ≥ 3 attempts), single quaternary paediatric hospital, April 2019 to January 2024
- Participants
- 559 encounters
- Exposure
- Hybrid technique vs videolaryngoscopy vs direct laryngoscopy
- Hybridn = 94
- Videolaryngoscopyn = 235reference
- Direct laryngoscopyn = 190reference
- Outcome
- First-attempt success rate and incidence of complications with each tracheal intubation technique
Methodological detailssingle-centre, quaternary paediatric hospital
- Single-centre
- Quaternary paediatric hospital
Main finding
As reported in the abstract
First-attempt success
Hybrid vs Videolaryngoscopy: P = 0.020 · Hybrid vs Direct laryngoscopy: P < 0.001
Observational data: associations, not effects.
Further findings
- Hybrid technique as rescue after unsuccessful videolaryngoscopy — Hybrid
- 70.4%
- Hybrid technique as rescue after unsuccessful videolaryngoscopy: 19/27 encounters where videolaryngoscopy alone was unsuccessful
Hybrid technique as rescue after unsuccessful videolaryngoscopy
- Hybrid rescue successful in all these encounters
Safety
At least one complication (co-primary outcome) — Hybrid vs Videolaryngoscopy
P = 0.025
| Outcome | P value |
|---|---|
| At least one complication (co-primary outcome)Hybrid vs Direct laryngoscopy | P < 0.001 |
| Complication rate by weight (subgroup)< 10 kg vs ≥ 10 kg | P < 0.001 |
- At least one complication (co-primary outcome) — Encounters with at least one complication, overall
- 86 (15.4%)
- Complication rate by weight (subgroup): < 10 kg 24.5%
- Complication rate by weight (subgroup): ≥ 10 kg 10.9%
- Complication rate by weight (subgroup): 45/184 vs 41/375
Original publication
Combined videolaryngoscopy and flexible bronchoscopy for difficult tracheal intubation in children: a retrospective observational cohort study. Anaesthesia. Published 22 May 2025. doi:10.
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