Universal paediatric videolaryngoscopy and glottic view grading: a prospective observational study.

Area of Science:

• Pediatric Anesthesiology
• Airway Management
• Medical Device Technology

Background:

• Limited evidence exists on universal videolaryngoscopy programs for pediatric tracheal intubation.
• Videolaryngoscopy is proposed as a default technique for pediatric intubation.

Purpose of the Study:

• To assess if universal, first-choice videolaryngoscopy reduces restricted glottic views in children.
• To evaluate the Cormack and Lehane classification's diagnostic performance for pediatric videolaryngoscopic intubation difficulty.

Main Methods:

• Prospective observational study within a universal videolaryngoscopy implementation program.
• Used C-MAC™ videolaryngoscopes for elective tracheal intubations in anesthetized children.
• Classified direct and videolaryngoscopic glottic views using a six-stage grading system.

Main Results:

• 904 tracheal intubations in 809 children over 16 months.
• Restricted glottic views decreased from 13% with direct laryngoscopy to 4% with videolaryngoscopy (p < 0.001).
• Cormack and Lehane classification showed poor discrimination for videolaryngoscopic intubation difficulty (AUC 0.68 vs. 0.80 for direct view, p = 0.005).

Conclusions:

• Universal, first-choice videolaryngoscopy substantially reduces restricted glottic views in pediatric tracheal intubation.
• The Cormack and Lehane classification is not a reliable tool for grading videolaryngoscopic intubation difficulty in children.