TY - JOUR
T1 - Clinical Impact of External Laryngeal Manipulation during Laryngoscopy on Tracheal Intubation Success in Critically Ill Children
AU - Kojima, Taiki
AU - Laverriere, Elizabeth K.
AU - Owen, Erin B.
AU - Harwayne-Gidansky, Ilana
AU - Shenoi, Asha N.
AU - Napolitano, Natalie
AU - Rehder, Kyle J.
AU - Adu-Darko, Michelle A.
AU - Nett, Sholeen T.
AU - Spear, Debbie
AU - Meyer, Keith
AU - Giuliano, John S.
AU - Tarquinio, Keiko M.
AU - Sanders, Ronald C.
AU - Lee, Jan Hau
AU - Simon, Dennis W.
AU - Vanderford, Paula A.
AU - Lee, Anthony Y.
AU - Brown, Calvin A.
AU - Skippen, Peter W.
AU - Breuer, Ryan K.
AU - Toedt-Pingel, Iris
AU - Parsons, Simon J.
AU - Gradidge, Eleanor A.
AU - Glater, Lily B.
AU - Culver, Kathleen
AU - Li, Simon
AU - Polikoff, Lee A.
AU - Howell, Joy D.
AU - Nuthall, Gabrielle
AU - Bysani, Gokul K.
AU - Graciano, Ana L.
AU - Emeriaud, Guillaume
AU - Saito, Osamu
AU - Orioles, Alberto
AU - Walson, Karen
AU - Jung, Philipp
AU - Al-Subu, Awni M.
AU - Ikeyama, Takanari
AU - Shetty, Rakshay
AU - Yoder, Kathleen M.
AU - Nadkarni, Vinay M.
AU - Nishisaki, Akira
N1 - Funding Information:
Dr. Napolitano’s institution received funding from research grants for clinical research with Nihon Kodhen, Philips/Respironics, Draeger, and Aerogon, and from consulting/advisory panel work for Aerogon, GeNO, and Actuated Medical; she received funding from being a member of a
Funding Information:
meetings, and she received other support from Allergy and Asthma Net-voluntary board of directors for organizations where travel is paid to attend Tracheal intubation (TI) in critically ill children is asso-work and American Association for Respiratory Care. Dr. Lee received ciated with substantial risks (1). Intubations requiring funding from UpToDate (royalties for medical writing), Airway Manage-funding from KK Women’s and Children’s Hospital. Dr. Brown III received multiple attempts to secure an airway have been associ- ment Education Center, LLC (partner), and Medical Legal Consulting. Dr. ated with oxygen desaturation, airway trauma, aspiration, pneu-Howell’s institution received funding from A+ Trust (money was paid to mothorax, laryngospasm, cardiac arrest, and death (2, 3). Proper lecting of the data that is included in the data set in this article). Dr. Eme-contribute to the salaries of the research nurses who contributed to col- visualization of the glottic opening and vocal cords is important riaud’s institution received funding from Young Investigator Award (to Dr. for a successful TI attempt. To improve glottic exposure, external Emeriaud) of the Respiratory Health Network of the Fonds de Recherche laryngeal manipulation (ELM), with external pressure applied of the Fonds de REcherche du Québec-Santé. Dr. Nishisaki’s institu-du Québec – Santé and from the Clinical Scientist Scholarship Award to the thyroid and cricoid cartilages, is routinely employed dur- tion received funding from Agency for Healthcare Research and Qual-ing direct laryngoscopy in both adults and children. The rec-ity (AHRQ) R03HS021583, R18HS022464, R18HS024511, and he ommended maneuver includes backward, upward, right-sided have disclosed that they do not have any potential conflicts of interest.received support for article research from AHRQ. The remaining authors pressure (BURP) on the thyroid and cricoid cartilages (4).
Funding Information:
Supported by Agency for Healthcare Research and Quality: AHRQ R03HS021583, AHRQ R18HS022464, AHRQ R18HS024511 (Drs.
Publisher Copyright:
© Copyright 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Objectives: External laryngeal manipulation is a commonly used maneuver to improve visualization of the glottis during tracheal intubation in children. However, the effectiveness to improve tracheal intubation attempt success rate in the nonanesthesia setting is not clear. The study objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in PICUs. Design: A retrospective observational study using a multicenter emergency airway quality improvement registry. Setting: Thirty-five PICUs within general and children's hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). Patients: Critically ill children (< 18 years) undergoing initial tracheal intubation with direct laryngoscopy in PICUs between July 1, 2010, and December 31, 2015. Measurements and Main Results: Propensity score-matched analysis was performed to evaluate the association between external laryngeal manipulation and initial attempt success while adjusting for underlying differences in patient and clinical care factors: age, obesity, tracheal intubation indications, difficult airway features, provider training level, and neuromuscular blockade use. External laryngeal manipulation was defined as any external force to the neck during laryngoscopy. Of the 7,825 tracheal intubations, the initial tracheal intubation attempt was successful in 1,935/3,274 intubations (59%) with external laryngeal manipulation and 3,086/4,551 (68%) without external laryngeal manipulation (unadjusted odds ratio, 0.69; 95% CI, 0.62-0.75; p < 0.001). In propensity score-matched analysis, external laryngeal manipulation remained associated with lower initial tracheal intubation attempt success (adjusted odds ratio, 0.93; 95% CI, 0.90-0.95; p < 0.001). Conclusions: External laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. The indiscriminate use of external laryngeal manipulation cannot be recommended.
AB - Objectives: External laryngeal manipulation is a commonly used maneuver to improve visualization of the glottis during tracheal intubation in children. However, the effectiveness to improve tracheal intubation attempt success rate in the nonanesthesia setting is not clear. The study objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in PICUs. Design: A retrospective observational study using a multicenter emergency airway quality improvement registry. Setting: Thirty-five PICUs within general and children's hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). Patients: Critically ill children (< 18 years) undergoing initial tracheal intubation with direct laryngoscopy in PICUs between July 1, 2010, and December 31, 2015. Measurements and Main Results: Propensity score-matched analysis was performed to evaluate the association between external laryngeal manipulation and initial attempt success while adjusting for underlying differences in patient and clinical care factors: age, obesity, tracheal intubation indications, difficult airway features, provider training level, and neuromuscular blockade use. External laryngeal manipulation was defined as any external force to the neck during laryngoscopy. Of the 7,825 tracheal intubations, the initial tracheal intubation attempt was successful in 1,935/3,274 intubations (59%) with external laryngeal manipulation and 3,086/4,551 (68%) without external laryngeal manipulation (unadjusted odds ratio, 0.69; 95% CI, 0.62-0.75; p < 0.001). In propensity score-matched analysis, external laryngeal manipulation remained associated with lower initial tracheal intubation attempt success (adjusted odds ratio, 0.93; 95% CI, 0.90-0.95; p < 0.001). Conclusions: External laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. The indiscriminate use of external laryngeal manipulation cannot be recommended.
UR - http://www.scopus.com/inward/record.url?scp=85048385520&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000001373
DO - 10.1097/PCC.0000000000001373
M3 - Journal articles
C2 - 29140970
AN - SCOPUS:85048385520
SN - 1529-7535
VL - 19
SP - 106
EP - 114
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 2
ER -
