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An observational study of feasibility of tracheal intubation using Airtraq in pediatric population
Devendra Wasudeo Thakare1, Anila Devchand Malde1
1Department of Anaesthesiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India.
Insights
The Airtraq (AT) device offers excellent visualization for pediatric intubation. However, the infant-sized AT (size 0) has a high failure rate compared to pediatric (size 1) and small (size 2) sizes.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Medical Device Technology
Background:
- Limited observational data exists on Airtraq (AT) device usage in pediatric patients, particularly infants.
- A prospective study was designed to evaluate the performance of different Airtraq sizes in children.
Purpose of the Study:
- To compare the ease of use and effectiveness of the infant (size 0), pediatric (size 1), and small (size 2) Airtraq devices for endotracheal intubation in children.
- To assess secondary outcomes including glottic visualization and intubation time.
Main Methods:
- A prospective observational study involving healthy pediatric patients aged 3 months to 18 years undergoing endotracheal intubation with Airtraq.
- Primary outcome: intubation success rate. Secondary outcomes: Percentage of Glottis Opening (POGO) score, Visual Analog Scale (VAS) for field of view and ease of use, Time to Best View (TTBV), and Time to Intubation (TTI).
Main Results:
- All Airtraq sizes provided excellent glottic visualization (POGO 100%) and field of view (VAS 10).
- Intubation success rates were 100% for AT size 1 and 2, but only 45% for AT size 0 (P < 0.001).
- Ease of use (VAS) was significantly lower for AT size 0 (5) compared to sizes 1 and 2 (10) (P < 0.001).
Conclusions:
- Airtraq devices (all sizes) facilitate rapid and clear glottic visualization.
- The infant-sized Airtraq (size 0) demonstrates a significantly higher failure rate for intubation compared to the pediatric (size 1) and small (size 2) sizes.
Background And Aim:
There is a paucity of observational studies for the use of Airtraq (AT) in children, especially infants. We undertook a prospective observational study to compare ease of use of infant (size 0), pediatric (size 1), and small (size 2) AT.
Material And Methods:
AT was used for endotracheal intubation in healthy pediatric patients of 3 months to 18 years age. The primary outcome was success of intubation which was noted as number (%) and analyzed using Fisher's exact test. The secondary outcomes were percentage of glottis opening (POGO) score, visual analog scale (VAS) for field of view, time to best view (TTBV), time to intubation (TTI), and VAS for ease of use and were presented as median (interquartile range) in each subgroup of sizes and analyzed using Kruskal-Wallis test.
Results:
Overall POGO score was 100 (100, 100 [50-100]) %, VAS field of view was 10 (10, 10 [5-10]), and TTBV was 6 (4, 10 [1.5-24]) s. There was no statistically significant difference in any of the subgroups. The success rate of intubation with AT was 100% with AT size 1 and 2, whereas 45% with AT 0, P < 0.001. VAS for ease of use was 5 (4, 10 [3-10]) with AT 0 compared to 10 (10, 10 [9-10]) with AT 1 and 10 (10, 10 [6-10]) with AT 2 (P < 0.001). TTI was 28 (20, 36 [11.8-59]) s in those who could be successfully intubated.
Conclusions:
All sizes of AT provide quick, easy, and excellent glottic visualization. However, failure rate for intubation with infant (size 0) is high compared to nil with pediatric (size 1) and small (size 2).
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