title: Evaluation of emergency pediatric tracheal intubation by pediatric anesthesiologists on inpatient units and the emergency department.
abstract: OBJECTIVE
  There are limited data on pediatric emergency tracheal intubation on inpatient units and in the emergency department by anesthesiologists. This retrospective cohort study was designed to describe the frequency of difficult intubation and adverse events associated with emergency tracheal intubation performed by pediatric anesthesiologists in a large children's hospital.
  
  
  METHODS
  All emergency tracheal intubation on inpatient units and the emergency department performed by pediatric anesthesiologists over a 7-year period in children <18 years were identified by querying our perioperative clinical information system. Medical records were comprehensively reviewed to describe the emergency intubation process and outcomes.
  
  
  RESULTS
  One hundred and thirty-two intubations from 120 children (median age 3.3 years) were eligible. The majority of emergency tracheal intubations were successful with 1-2 laryngoscopy attempts, while 14 (10.6%) were difficult. Despite grade 3 view in 3/14 cases, the airway was secured after multiple direct laryngoscopy attempts. Eleven required use of an alternative airway device to secure the airway. A preexisting airway abnormality or craniofacial abnormality was present in 57% of cases with difficult intubation including half with micrognathia or retrognathia. Major intubation-related adverse events such as aspiration, occurred in 5 (3.8%) emergency tracheal intubations. Mild-to-moderate intubation-related adverse events occurred in 23 (17.4%) emergency tracheal intubations including mainstem bronchus intubation (13.6%).
  
  
  CONCLUSIONS
  A significant rate of difficult intubation and mild-to-moderate intubation-related adverse events were found in emergency tracheal intubations on inpatient units and the emergency department in children performed by a pediatric anesthesiology emergency airway team. Difficult intubation was observed frequently in children with preexisting airway and craniofacial abnormalities and often required the use of an alternative airway device to successfully secure the airway.
authors.affiliation: Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Wenyu
authors.initials: W
authors.lastname: Bai
authors.affiliation: Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Golmirzaie
authors.affiliation: Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Constance
authors.initials: C
authors.lastname: Burke
authors.affiliation: Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Van Veen
authors.affiliation: Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Christensen
authors.affiliation: Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Terri
authors.initials: T
authors.lastname: Voepel-Lewis
authors.affiliation: Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Shobha
authors.initials: S
authors.lastname: Malviya
mesh_terms: D058109:Airway Management / Q000379:methods; D000072080:Anesthesiologists; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019465:Craniofacial Abnormalities; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D007828:Laryngoscopy; D019990:Perioperative Care; D015619:Respiratory System Abnormalities; D012189:Retrospective Studies
keywords: adverse effects; airway management; anesthesiology; emergencies; intubation; pediatrics