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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Factors Associated With Pediatric Emergency Airway Management by the Difficult Airway Response Team
Nicholas M Dalesio1,2, Lauren Burgunder3, Natalia M Diaz-Rodriguez2
1Otolaryngology/Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
Insights
Difficult airway risk factors differ between pediatric patients managed by the difficult airway response team (DART) and rapid response team (RRT). Specific factors like craniofacial abnormalities and airway swelling predict DART intervention, improving pediatric airway management.
Area of Science:
- Pediatric Emergency Medicine
- Anesthesiology
- Critical Care
Background:
- Identifying risk factors for difficult airways in children is crucial for timely intervention.
- Comparing patient populations managed by specialized teams like the Difficult Airway Response Team (DART) and Rapid Response Team (RRT) can reveal distinct clinical profiles.
Purpose of the Study:
- To determine if difficult airway risk factors are similar in pediatric patients managed by the DART versus the RRT.
- To identify predictors for DART intervention in pediatric airway emergencies.
Main Methods:
- Retrospective analysis of prospectively collected data from 110 pediatric patients.
- Inclusion of patient demographics, comorbidities, history of difficult intubation, and intubation event details.
- Comparison of risk factors between DART and RRT managed patients.
Main Results:
- DART patients were older (median 8.5 years) than RRT patients (median 0.3 years).
- Higher odds of DART management were observed in children aged 1-2 years and >5 years.
- DART patients more frequently had craniofacial abnormalities, airway swelling, or trauma.
Conclusions:
- Specific clinical risk factors predict the need for emergency airway management by the DART in pediatric settings.
- Coordinated DART use may reduce endotracheal tube placement attempts and associated morbidity.
Abstract:
Background The goal of this study was to determine if difficult airway risk factors were similar in children cared for by the difficult airway response team (DART) and those cared for by the rapid response team (RRT). Methods In this retrospective database analysis of prospectively collected data, we analyzed patient demographics, comorbidities, history of difficult intubation, and intubation event details, including time and place of the emergency and devices used to successfully secure the airway. Results Within the 110-patient cohort, median age (IQR) was higher among DART patients than among RRT patients [8.5 years (0.9-14.6) versus 0.3 years (0.04-3.6); P < 0.001]. The odds of DART management were higher for children ages 1-2 years (aOR, 43.3; 95% CI: 2.73-684.3) and >5 years (aOR, 13.1; 95% CI: 1.85-93.4) than for those less than one-year-old. DART patients were more likely to have craniofacial abnormalities (aOR, 51.6; 95% CI: 2.50-1065.1), airway swelling (aOR, 240.1; 95% CI: 13.6-4237.2), or trauma (all DART managed). Among patients intubated by the DART, children with a history of difficult airway were more likely to have musculoskeletal (P = 0.04) and craniofacial abnormalities (P < 0.001), whereas children without a known history of difficult airway were more likely to have airway swelling (P = 0.04). Conclusion Specific clinical risk factors predict the need for emergency airway management by the DART in the pediatric hospital setting. The coordinated use of a DART to respond to difficult airway emergencies may limit attempts at endotracheal tube placement and mitigate morbidity.
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