Research in context
Evidence before the study
Findings of single centre studies in adults have shown that repeated conventional tracheal intubation attempts in critically ill patients contribute to patient morbidity. Multicentre studies from paediatric intensive care units suggest that critically ill children are at high risk of complications during airway management in the intensive care unit. Little is known about the complications and associated risk factors of airway management in children with difficult tracheal intubation cared for by anaesthesiologists. Before undertaking this study we searched the scientific literature published between October, 1975, and October, 2011, with the terms “pediatric difficult intubation”, “difficult airway”, “difficult direct laryngoscopy”, “difficult tracheal intubation”, “complications and pediatric intubation”, “anesthesiology and pediatric difficult intubation” in various combinations. We filtered our results to exclude adult studies, case reports, and case series. We found no relevant large multicentre trials directly relating to this topic. The aim of our study was to establish the complications and their associated risk factors in children included in a prospective multicentre difficult tracheal intubation registry.
Added value of this study
This study is the first to assess the complications of children with difficult tracheal intubation as established by anaesthesiologists. This study establishes the complication rates in these patients, identifies the risk factors for complications, and estimates the incidence of difficult tracheal intubation in children under anaesthesia care. This study has identified a high complication rate. This finding should encourage further investigations and a change in clinical practice patterns to enhance patient safety.
Implications of all the available evidence
Children with difficult tracheal intubation are a high-risk group and multiple tracheal intubation attempts are a key risk factor for complications. Clinicians should treat every tracheal intubation attempt as a critical intervention and should limit the number of direct laryngoscopy and tracheal intubation attempts in this population. Future research should investigate interventions to reduce these complications such as checklists and care protocols. Additionally, the role and efficacy of passive oxygenation during tracheal intubation is unclear and should be investigated.