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Airway management in paediatric anaesthesia in Europe-insights from APRICOT (Anaesthesia Practice In Children
T Engelhardt1, K Virag2, F Veyckemans3
1Department of Paediatric Anaesthesia, Royal Aberdeen Children's Hospital and University of Aberdeen, Aberdeen, UK.
Insights
Critical respiratory events in children during anesthesia are linked to airway management difficulties. Multiple intubation attempts and pre-existing respiratory issues significantly increase the risk of these events, necessitating improved preoperative assessment.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Critical Care Medicine
Background:
- Critical respiratory events are frequent in the peri-anaesthetic period for children.
- These events stem from challenges in airway and ventilation management.
- European paediatric airway management practices require analysis.
Purpose of the Study:
- To analyze European paediatric airway management practices.
- To determine the incidence of difficult airway management in children.
- To identify consequences of difficult airway management.
Main Methods:
- Secondary analysis of the European multicentre observational trial (Anaesthesia PRactice in Children Observational Trial, APRICOT).
- Included children from birth to 15 years of age.
- Primary endpoint: incidence of difficult airway management; Secondary endpoints: association with respiratory risk factors and critical respiratory events.
Main Results:
- Analysis of 31,024 anaesthetic procedures.
- Failed tracheal intubation: 0.08%; failed supraglottic airway: 0.08%.
- Difficulties securing airway increased critical respiratory event risk (OR 2.1 for tracheal tube, 4.3 for supraglottic airway). Pre-existing respiratory factors were significant predictors.
Conclusions:
- Paediatric airway management practices show wide variation across Europe.
- Multiple airway device attempts and pre-existing respiratory risk factors elevate critical respiratory event likelihood.
- Enhanced preoperative assessment, education, research, and training are crucial for improving perioperative care.
Background:
Critical respiratory events are common in children in the peri-anaesthetic period and are caused by airway and ventilation management difficulties. We aimed to analyse current European paediatric airway management practices and identify the incidence and potential consequences of difficult airway management.
Methods:
We performed a secondary analysis of airway and ventilation management details of the European multicentre observational trial (Anaesthesia PRactice in Children Observational Trial, APRICOT) of children from birth to 15 yr of age. The primary endpoint was the incidence of difficult airway management. Secondary endpoints were the associations between difficult airway management, known pre-existing respiratory risk factors, and the occurrence of critical respiratory events.
Results:
Details for 31 024 anaesthetic procedures were available for analysis. Three or more tracheal intubation attempts were necessary in 120 children (0.9%) and in 40 children (0.4%) for supraglottic airways insertions. The incidence (95% confidence interval) for failed tracheal intubation and failed supraglottic airway insertions was 8/10 000 (0.08%; 0.03-0.13%) and 8.2/10 000 (0.08%; 0.03-0.14%) children, respectively. Difficulties in securing the airway increased the risk for a critical respiratory event for tracheal tube (2.1; 1.3-3.4) and supraglottic airway (4.3; 1.9-9.9) placement. History of pre-existing respiratory risk factors was significantly associated with critical respiratory events independently of the airway device used.
Conclusions:
Airway management practices vary widely across Europe. Multiple airway device insertion attempts and pre-existing respiratory risk factors increase the likelihood of critical respiratory events in children and require further stratification during preoperative assessment and planning. This study highlights areas where education, research, and training may improve perioperative care.
Clinical Trial Registration:
NCT01878760.
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