Pediatric anesthesia & critical care
Comparing videolaryngoscopy and flexible bronchoscopy to rescue failed direct laryngoscopy in children: a propensity score matched analysis of the Pediatric Difficult Intubation Registry
Authors' conclusion
Videolaryngoscopy was chosen more frequently than flexible bronchoscopy as a rescue technique in a cohort of children with difficult direct laryngoscopy, with similar success and complication rates. For small infants, flexible bronchoscopy had a higher eventual success rate
Study context
- Population
- Children with difficult tracheal intubation and failed initial direct laryngoscopy, Pediatric Difficult Intubation Registry, August 2012-September 2023failed direct laryngoscopy
- Participants
- 2,281 children
- Exposure
- Videolaryngoscopy vs Flexible bronchoscopy
- Outcome
- Success rates (first-attempt and eventual success)
Methodological detailspropensity score matched, multicentre registry
- Propensity score matched
- Multicentre registry
Main finding
As reported in the abstract
First-attempt success, eventual success (matched cohort)
- Propensity score matched cohorts did not differ in first-attempt success or eventual success
- Propensity score matched cohort
Observational data: associations, not effects.
Further findings
Choice of rescue technique after failed direct laryngoscopy (all cases) · denominator 2281
P < 0.001
Choice of rescue technique after failed direct laryngoscopy (subgroup infants < 5 kg) · denominator 543
P < 0.001
| Outcome | Videolaryngoscopy | Flexible bronchoscopy | Estimate | P value | |
|---|---|---|---|---|---|
| First-attempt success (subgroup infants < 5 kg)Matched patients | 43% | 62% | OR for first-attempt success 2.19 (95% CI 0.96–4.98) | P = 0.061 | |
| Eventual success (subgroup infants < 5 kg)Matched patients | 71% | 90% | OR for eventual success 3.53 (95% CI 1.03–12.2) | P = 0.046 | |
| 0.050.21520Ratio (log scale) |
Safety
Complications
- Did not differ between the techniques (matched cohort and infants < 5 kg)
Original publication
Comparing videolaryngoscopy and flexible bronchoscopy to rescue failed direct laryngoscopy in children: a propensity score matched analysis of the Pediatric Difficult Intubation Registry. Anaesthesia. Published 20 March 2025. doi:10.
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