Pediatric Trainees Managing a Difficult Airway: Comparison of Laryngeal Mask Airway, Direct, and Video-Assisted Laryngoscopy

A view on pediatric airway management: a cross sectional survey study

BACKGROUND

This survey aimed to investigate routine practices and approaches of clinicians on pediatric airway in anesthesia and intensive care medicine.

METHODS

A 20-question multiple-choice questionnaire with the possibility to provide open text answers was developed and sent. The survey was sent to the members of European Airway Management Society via a web-based platform. Responses were analyzed thematically. Only the answers from one representative of the pediatric service of each hospital was included into the analysis.

RESULTS

Among the members, 143 physicians responded the survey, being anesthesiologists (83.2%), intensivists (11.9%), emergency medicine physicians (2.1%), and (2.8%) pain medicine practitioners. A straight blade was preferred by 115 participants (80.4%) in newborns, whereas in infants 86 (60.1%) indicated a curved blade and 55 (38.5%) a straight blade. Uncuffed tracheal tube were preferred by 115 participants (80.4%) in newborns, whereas 24 (16.8%) used cuffed tubes. Approximately 2/3 of the participants (89, 62.2%) reported not to use routinely a cuff manometer in their clinical practice, whereas 54 participants (37.8%) use it routinely in pediatric patients. Direct laryngoscopy for routine pediatric tracheal intubation was reported by 127 participants (88.8%), while 16 (11.2%) reported using videolaryngoscopes routinely. Interestingly, 39 (27.3%) had never performed neither videolaryngoscopy nor flexible bronchoscopy in children. These results were significantly less in hospitals with a dedicated pediatric anesthesiologist.

CONCLUSIONS

This survey on airway management in pediatric anesthesia revealed that the use of cuffed tubes and the routine monitoring of cuff pressure are rare. In addition, the rate of videolaryngoscopy or flexible optical intubation was low for expected difficult intubation. Our survey highlights the need for properly trained pediatric anesthesiologists working in-line with updated scientific evidence.

Effectiveness of an Advanced Airway Training "Boot Camp" for Family Medicine Physician Trainees

OBJECTIVE

This course was designed to characterize the impact of a curriculum for training family medicine physicians in advanced airway techniques with respect to intubation performance and learner confidence.

METHODS

A training course was introduced into the curriculum in a single-group pretest-posttest model at a community family medicine residency program. Training consisted of a didactic teaching session on airway management and hands-on skill session with direct laryngoscopy (DL) and video-assisted laryngoscopy (VAL) on normal and difficult airway simulators. Participants were scored with the Intubation Difficulty Scale and completed surveys before and after the training.

RESULTS

Twenty-eight residents of all levels participated. The mean time to successful intubation was significantly decreased after training from 51.96 to 23.71 seconds for DL and from 27.89 to 17.07 seconds for VAL. Participant scores with the Intubation Difficulty Scale were also significantly improved for DL and VAL. All participants rated their comfort levels with both techniques as high following training.

DISCUSSION

Advanced airway management is a critical skill for any physician involved in caring for critically ill patients, though few trainees receive formal training. Addition of an airway training course with simulation and hands-on experience can improve trainee proficiency and comfort with advanced airway techniques.

IMPLICATIONS FOR PRACTICE

Training on airway management should be included in the curriculum for trainees who require the requisite skills and knowledge necessary for advanced airway interventions. This introductory project demonstrates the efficacy and feasibility of a relatively brief training as part of a family medicine residency curriculum.

Development of a Cost-Effective Pediatric Intubation Task Trainer for Rural Medical Education

Pediatric intubation and airway management (PIAM) is a life-saving, emergent procedure that is performed by a variety of healthcare practitioners. Securing the pediatric airway in a time-sensitive fashion is a specialized skill that declines with lack of practice, leading to a precarious gap in clinical competency and healthcare delivery. However, current training models for PIAM, such as live animals, human cadavers, and simulators, are not adequately accessible or reliable due to their combination of high cost, unrealistic simulation, lack of standardization, and ethical concerns. Task trainers pose an ethically and fiscally sustainable training model for experiential learning through repetitive practice, which has been shown to dramatically improve trainee proficiency and confidence in performing high-acuity low-occurrence procedures such as pediatric intubation. This work aims to report the development process and initial validation evidence of a prototype cost-effective pediatric intubation task trainer that can be used for post-graduate education, especially in resource-challenged settings.