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Evaluating Airway Management in Patients With Trisomy 21 in the PICU and Cardiac ICU: A Retrospective Cohort Study

Eric J Wilsterman1, Marianne E Nellis1, Josep Panisello2

  • 1Pediatric Critical Care, Department of Pediatrics, New York Presbyterian Weill Cornell Medical Center, New York, NY.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|December 7, 2023
PubMed

Insights

Tracheal intubation in children with trisomy 21 did not show increased adverse airway outcomes, despite unique airway challenges. This study analyzed intubation data from critically ill children to assess risks.

Area of Science:

  • Pediatric Critical Care Medicine
  • Airway Management
  • Genetics

Background:

  • Children with trisomy 21 (Down syndrome) present with specific anatomical and physiological characteristics that can complicate tracheal intubation.
  • Tracheal intubation (TI) in critically ill children with trisomy 21 is not extensively documented.
  • Existing literature suggests potential challenges, but empirical data on adverse outcomes is limited.

Purpose of the Study:

  • To investigate the association between trisomy 21 and adverse airway outcomes (AAOs) during tracheal intubation in critically ill children.
  • To compare the incidence of TI-associated events (TIAEs) and peri-intubation hypoxemia in children with and without trisomy 21.
  • To determine if trisomy 21 diagnosis increases the risk of complications during emergency airway procedures.

Main Methods:

  • A retrospective analysis of tracheal intubation data was conducted using the National Emergency Airway Registry for Children (NEAR4KIDS) database.
  • The study included children under 18 years old undergoing TI in pediatric or cardiac intensive care units between January 2014 and December 2020.
  • Propensity-score matching was employed to compare outcomes between children with trisomy 21 and a matched control group.

Main Results:

  • The study analyzed 8401 tracheal intubations, with 274 (3.3%) involving children with trisomy 21.
  • Children with trisomy 21 had lower median weight, higher rates of intubation for oxygenation/ventilation failure, and more difficult airway features, including upper airway obstruction.
  • Despite these differences, after propensity-score matching, no significant association was found between trisomy 21 and increased rates of adverse airway outcomes (AAOs).

Conclusions:

  • While children with trisomy 21 exhibit distinct airway risk factors and varied intubation approaches, the diagnosis itself was not associated with a higher incidence of adverse airway outcomes.
  • The findings suggest that with appropriate management, tracheal intubation can be performed safely in critically ill children with trisomy 21.
  • Further research may explore specific management strategies that mitigate risks in this population.
Abstract

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