Pediatric anesthesia & critical care
Preemptive airway management planning: A retrospective evaluation of the pediatric difficult airway consultation service
Authors' conclusion
In our study, nurse-screening identified patients at high-risk for a difficult airway that would likely not have been identified prior to initiation of a screening protocol.
Study context
- Population
- Children referred to the pediatric Difficult Airway Consultation Service (pDACS) over a 4-year period
- Participants
- 419 consults
- Exposure
- Physician-initiated vs Nurse-initiated
- Nurse-initiatedn = 179reference
- Physician-initiatedn = 108
- Nurse-and-physician-initiatedn = 71
- Outcome
- Consult source and difficult-airway risk factors
Main finding
As reported in the abstract
Difference
26.7%
95% CI 14.0%–39.4%
P < 0.001
Events by group
Physician-initiated vs Nurse-initiated
difference 26.7% (95% CI 14.0%–39.4%); P < 0.001
- Airway edema, difference in observed frequency (higher in physician- vs nurse-initiated consults); 95%CI 0.1%-12.5%, p = .04
- 6.3%
- Cleft lip/palate, difference in observed frequency (higher in physician- vs nurse-initiated consults); 95%CI 0.07%-16.3%, p = .04
- 8.1%
- Craniofacial abnormalities, difference in observed frequency (higher in physician- vs nurse-initiated consults); 95%CI 1.9%-22.7%, p = .02
- 12.3%
- Trauma/burn, difference in observed frequency (higher in physician- vs nurse-initiated consults); 95%CI 0.09%-12.8%, p = .04
- 6.5%
- Airway edema more prevalent in dual nurse-and-physician-initiated consults; 95%CI 1.6%-15.8%, p = .01
- 8.7%
- High-risk patients identified by nurse-screening only
- 41.9%
Observational data: associations, not effects.
Further findings
Recommended airway management plans
- Bag-valve-mask as primary ventilation recommendation (n = 108)
- 89.3%
- SGA as most common tertiary plan (n = 83)
- 74.2%
- Direct laryngoscopy recommended (n = 65)
- 47.1%
- Videolaryngoscopy recommended (n = 56)
- 40.6%
Airway emergencies with prior documented plan
- Patients successfully intubated without complications using recommended primary technique
- 3
Original publication
Preemptive airway management planning: A retrospective evaluation of the pediatric difficult airway consultation service. Acta Anaesthesiol Scand. Published 24 July 2024. doi:10.
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