Fibreoptic and videoscopic indirect intubation techniques for intubation in children

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway

The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.

Flexible bronchoscopy as a valuable diagnostic and therapeutic tool in pediatric intensive care patients: a report on 5 years of experience

OBJECTIVE

To evaluate the clinical role of flexible bronchoscopy (FB) in pediatric and neonatal intensive care units (ICUs).

DESIGN

A retrospective review of all patients receiving FB procedures between January 2005 and December 2009.

SETTING

Pediatric and neonatal ICUs of a tertiary care multi-disciplinary teaching hospital located in northern Taiwan.

PATIENTS

A total of 358 ICU patients (223 males) who received 725 FB procedures.

MEASUREMENTS AND MAIN RESULTS

The medical records were reviewed and analyzed. Mean age for the first time FB was 35.7 (±48.9 SD) months old and 68.2% of them were <3 years old. Among them, unexplained retraction or tachypnea (32.0%) and stridor (20.1%) were the two leading indications for FB. The positive finding rate of FB was 87.2%, with airway malacia (47.8%) being the most common, especially in patients <3 years old. Positive lesion sites were approximately equally distributed between the upper (51.1%) and lower (50.6%) airways. Concomitant findings in the esophagus were found in 15.4% of the patients. There were 518 interventional FBs (71.4%, 518/725 procedures) which were performed on 201 (56.1%, 201/358) patients; FB-aided endotracheal intubation (180/518, 34.7%) and laser therapy (109/518, 21.0%) were the two leading techniques used. No patient suffered from any long-term complications or mortality associated with the FB procedures.

CONCLUSIONS

FB is a safe and valuable diagnostic and therapeutic tool for patients in pediatric and neonatal ICUs.