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The selection of ventilation devices in children with mild or moderate upper respiratory tract infections: a
Jing Shi1, Xiang Liu2, Wenjing Chen2
1Department of Anesthesiology, Hebei Children's Hospital, NO.166 jianhuanan street, Shijiazhuang, Hebei, 050000, China. shij10208jing@163.com.
Insights
Using a supraglottic airway (SGA) significantly reduces respiratory adverse events in children with mild or moderate upper respiratory tract infections (URTIs) compared to endotracheal tubes (ETT). This airway management technique offers a safer alternative for pediatric anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Airway Management
- Respiratory Medicine
Background:
- Children with upper respiratory tract infections (URTIs) face increased risks of perioperative respiratory adverse events (PRAEs) during anesthesia.
- Supraglottic airway (SGA) devices are explored as a potentially safer alternative to endotracheal tubes (ETT) for airway management in this population.
Purpose of the Study:
- To evaluate if using SGA instead of ETT reduces PRAEs in pediatric patients with mild to moderate URTIs.
- To compare the incidence of specific adverse events between SGA and ETT groups.
Main Methods:
- A randomized controlled trial involving 78 pediatric patients with mild/moderate URTIs.
- Patients received either SGA or ETT for airway management.
- Monitoring for adverse events including cough, laryngospasm, bronchospasm, breath-holding, stridor, and desaturation throughout the perioperative period.
Main Results:
- Overall PRAEs occurred in 56.4% of patients; 77.5% in the ETT group vs. 34.1% in the SGA group.
- SGA use was associated with a significantly lower relative risk (RR) of PRAEs (0.417) compared to ETT (p < 0.001).
- The incidence of minor PRAEs, perioperative cough, and oxygen desaturation was significantly lower in the SGA group.
Conclusions:
- Supraglottic airway (SGA) devices are an acceptable and effective alternative to endotracheal tubes (ETT) for managing airways in children with mild or moderate URTIs.
- SGA use significantly reduces the occurrence of coughing, bronchospasm, and oxygen desaturation, thereby improving patient safety.
Purpose:
Administering anaesthesia to children with upper respiratory tract infections (URTIs) increases the risk of perioperative respiratory adverse events (PRAEs). Several observational studies have suggested that the supraglottic airway (SGA) technique could be a potential alternative for airway management in children. This randomised controlled trial assesses whether using a SGA instead of an endotracheal tube (ETT) in children with mild or moderate URTIs affects the incidence of PRAEs.
Methods:
A total of 78 paediatric patients with mild or moderate URTIs who received either a SGA or ETT were included. Patients were monitored for adverse events such as cough, laryngospasm, bronchospasm, breath-holding, postoperative stridor or desaturation (< 90%) during the following stages: induction of anaesthesia, tube placement, surgery, tube removal and postanaesthesia care.
Results:
Throughout the perioperative period, 56.4% (44/78) of children experienced PRAEs. The incidence was 77.5% (31/40) in those receiving ETT and 34.1% (13/38) in those receiving SGA. The relative risk (RR) of PRAEs in children receiving SGA was 0.417 (95% CI: 0.248-0.701) compared with those receiving ETT (p < 0.001). Specifically, the incidence of minor PRAEs was significantly lower in the SGA group (28.9%, 11/38) compared with the ETT group (67.5%, 27/40) (RR: 0.429, 95% CI: 0.249-0.738, p < 0.001). There were significant differences between the groups in the incidence of perioperative cough (p = 0.043) and desaturation (p = 0.031).
Conclusion:
Using a SGA reduced the incidence of coughing, bronchospasm and oxygen desaturation, providing an acceptable alternative to ETT in children with mild or moderate URTIs.
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