Difficult intubation in syndromic versus nonsyndromic forms of micrognathia in children
© 2024 Acta Anaesthesiologica Scandinavica Foundation..
BACKGROUND: We investigated how syndromic versus nonsyndromic forms of micrognathia impacted difficult intubation outcomes in children. Primary outcome was the first-attempt success rate of tracheal intubation, secondary outcomes were number of intubation attempts and complications. We hypothesized that syndromic micrognathia would be associated with lower first-attempt success rate.
METHODS: In micrognathic patients enrolled in the Pediatric Difficult Intubation Registry (08/2012-03/2019) we retrospectively compared demographic and clinical characteristics between children with nonsyndromic and syndromic micrognathia using standardized mean differences (SMD) and assessed the association of the presence of syndrome with the primary and secondary outcomes using propensity score matching analysis with and without matching for airway assessment findings.
RESULTS: Nonsyndromic patients (628) were less likely to have additional airway abnormalities. Syndromic patients (216) were less likely to have unanticipated difficult intubation (2% vs. 20%, SMD 0.59). First-attempt success rates of intubation were: 38% in the syndromic versus 34% in the nonsyndromic group (odds ratio [OR] 1.18; 95% confidence intervals [95% CI] 0.74, 1.89; p = .478), and 37% versus 37% (OR 0.99; 95% CI 0.66, 1.48; p = .959). Median number of intubation attempts were 2 (interquartile range [IQR]: 1, 3; range: 1, 8) versus 2 (IQR: 1, 3; range 1, 12) (median regression coefficient = 0; 95% CI: -0.7, 0.7; p = .999) and 2 (IQR: 1, 3; range: 1, 12) versus 2 (IQR: 1, 3; range 1, 8) (median regression coefficient = 0; 95% CI: -0.5, 0.5; p = .999). Complication rates were 14% versus 22% (OR 0.6; 95% CI 0.34, 1.04; p = .07) and 16% versus 21% (OR 0.71; 95% CI 0.43, 1.17; p = .185).
CONCLUSIONS: Presence of syndrome was not associated with lower first-attempt success rate on intubation, number of intubation attempts, or complication rate among micrognathic patients difficult to intubate, despite more associated craniofacial abnormalities. Nonsyndromic patients were more likely to have unanticipated difficult intubations, first attempt with direct laryngoscopy.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:68 |
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| Enthalten in: |
Acta anaesthesiologica Scandinavica - 68(2024), 4 vom: 28. März, Seite 466-475 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hunyady, Agnes I [VerfasserIn] |
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| Links: |
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| Themen: |
Difficult intubation |
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| Anmerkungen: |
Date Completed 19.03.2024 Date Revised 19.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/aas.14369 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 100 | 1 | |a Hunyady, Agnes I |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Difficult intubation in syndromic versus nonsyndromic forms of micrognathia in children |
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| 500 | |a Date Completed 19.03.2024 | ||
| 500 | |a Date Revised 19.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2024 Acta Anaesthesiologica Scandinavica Foundation. | ||
| 520 | |a BACKGROUND: We investigated how syndromic versus nonsyndromic forms of micrognathia impacted difficult intubation outcomes in children. Primary outcome was the first-attempt success rate of tracheal intubation, secondary outcomes were number of intubation attempts and complications. We hypothesized that syndromic micrognathia would be associated with lower first-attempt success rate | ||
| 520 | |a METHODS: In micrognathic patients enrolled in the Pediatric Difficult Intubation Registry (08/2012-03/2019) we retrospectively compared demographic and clinical characteristics between children with nonsyndromic and syndromic micrognathia using standardized mean differences (SMD) and assessed the association of the presence of syndrome with the primary and secondary outcomes using propensity score matching analysis with and without matching for airway assessment findings | ||
| 520 | |a RESULTS: Nonsyndromic patients (628) were less likely to have additional airway abnormalities. Syndromic patients (216) were less likely to have unanticipated difficult intubation (2% vs. 20%, SMD 0.59). First-attempt success rates of intubation were: 38% in the syndromic versus 34% in the nonsyndromic group (odds ratio [OR] 1.18; 95% confidence intervals [95% CI] 0.74, 1.89; p = .478), and 37% versus 37% (OR 0.99; 95% CI 0.66, 1.48; p = .959). Median number of intubation attempts were 2 (interquartile range [IQR]: 1, 3; range: 1, 8) versus 2 (IQR: 1, 3; range 1, 12) (median regression coefficient = 0; 95% CI: -0.7, 0.7; p = .999) and 2 (IQR: 1, 3; range: 1, 12) versus 2 (IQR: 1, 3; range 1, 8) (median regression coefficient = 0; 95% CI: -0.5, 0.5; p = .999). Complication rates were 14% versus 22% (OR 0.6; 95% CI 0.34, 1.04; p = .07) and 16% versus 21% (OR 0.71; 95% CI 0.43, 1.17; p = .185) | ||
| 520 | |a CONCLUSIONS: Presence of syndrome was not associated with lower first-attempt success rate on intubation, number of intubation attempts, or complication rate among micrognathic patients difficult to intubate, despite more associated craniofacial abnormalities. Nonsyndromic patients were more likely to have unanticipated difficult intubations, first attempt with direct laryngoscopy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a difficult intubation | |
| 650 | 4 | |a endotracheal intubation | |
| 650 | 4 | |a micrognathia | |
| 650 | 4 | |a pediatric difficult airway | |
| 650 | 4 | |a syndromic children | |
| 650 | 4 | |a syndromic micrognathia | |
| 700 | 1 | |a Sergeeva, Vera |e verfasserin |4 aut | |
| 700 | 1 | |a Kovatsis, Pete G |e verfasserin |4 aut | |
| 700 | 1 | |a Evans, Kelly N |e verfasserin |4 aut | |
| 700 | 1 | |a Staffa, Steven J |e verfasserin |4 aut | |
| 700 | 1 | |a Zurakowski, David |e verfasserin |4 aut | |
| 700 | 1 | |a Fiadjoe, John E |e verfasserin |4 aut | |
| 700 | 1 | |a Jimenez, Nathalia |e verfasserin |4 aut | |
| 700 | 0 | |a Members of the Pediatric Difficult Intubation Research Consortium |e verfasserin |4 aut | |
| 700 | 1 | |a von Ungern-Sternberg, Britta S |e investigator |4 oth | |
| 700 | 1 | |a Sommerfield, David |e investigator |4 oth | |
| 700 | 1 | |a Hauser, Neil |e investigator |4 oth | |
| 700 | 1 | |a Taicher, Brad M |e investigator |4 oth | |
| 700 | 1 | |a Dalesio, Nicholas M |e investigator |4 oth | |
| 700 | 1 | |a Matuszczak, Maria |e investigator |4 oth | |
| 700 | 1 | |a Garcia-Marcinkiewicz, Annery G |e investigator |4 oth | |
| 700 | 1 | |a Bruins, Benjamin B |e investigator |4 oth | |
| 700 | 1 | |a Kodavatiganti, Ramesh |e investigator |4 oth | |
| 700 | 1 | |a Hsu, Grace |e investigator |4 oth | |
| 700 | 1 | |a Ward, Christopher |e investigator |4 oth | |
| 700 | 1 | |a Struyk, Brian |e investigator |4 oth | |
| 700 | 1 | |a Nishisaki, Akira |e investigator |4 oth | |
| 700 | 1 | |a McGovern, Elizabeth |e investigator |4 oth | |
| 700 | 1 | |a Robertson, Sara B |e investigator |4 oth | |
| 700 | 1 | |a Ravula, Niroop R |e investigator |4 oth | |
| 700 | 1 | |a Vega, Eduardo |e investigator |4 oth | |
| 700 | 1 | |a Meserve, Jonathan |e investigator |4 oth | |
| 700 | 1 | |a Park, Raymond S |e investigator |4 oth | |
| 700 | 1 | |a Peyton, James M |e investigator |4 oth | |
| 700 | 1 | |a Stein, Mary Lyn |e investigator |4 oth | |
| 700 | 1 | |a Matava, Clyde T |e investigator |4 oth | |
| 700 | 1 | |a Bordini, Martina |e investigator |4 oth | |
| 700 | 1 | |a Caldeira, Monica |e investigator |4 oth | |
| 700 | 1 | |a Nykiel-Bailey, Sydney |e investigator |4 oth | |
| 700 | 1 | |a Crockett, Christy J |e investigator |4 oth | |
| 700 | 1 | |a Bhattacharya, Somaletha T |e investigator |4 oth | |
| 700 | 1 | |a Sarmiento, Lina |e investigator |4 oth | |
| 700 | 1 | |a Olomu, Patrick N |e investigator |4 oth | |
| 700 | 1 | |a Kiss, Edgar E |e investigator |4 oth | |
| 700 | 1 | |a Szmuk, Peter |e investigator |4 oth | |
| 700 | 1 | |a Battles, Rhae E |e investigator |4 oth | |
| 700 | 1 | |a Lee, Angela C |e investigator |4 oth | |
| 700 | 1 | |a Heitmiller, Eugenie |e investigator |4 oth | |
| 700 | 1 | |a Marsh, Jennifer |e investigator |4 oth | |
| 700 | 1 | |a Singh, Neeta |e investigator |4 oth | |
| 700 | 1 | |a Reynolds, Paul |e investigator |4 oth | |
| 700 | 1 | |a Haydar, Bishr |e investigator |4 oth | |
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