Randomized comparison of experts and trainees with nasal and oral fibreoptic intubation in children less than 2 yr of age.

Autor:	Jagannathan N; Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA simjag2000@yahoo.com., Sequera-Ramos L; Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA., Sohn L; Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA., Huang A; Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA., Sawardekar A; Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA., Wasson N; Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA., Miriyala A; Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 19, Chicago, IL, USA., De Oliveira GS; Feinberg School of Medicine, Northwestern University, 303 E Chicago Ave, Chicago, IL 60611, USA.
Jazyk:	angličtina
Zdroj:	British journal of anaesthesia [Br J Anaesth] 2015 Feb; Vol. 114 (2), pp. 290-6. Date of Electronic Publication: 2014 Nov 05.
DOI:	10.1093/bja/aeu370
Abstrakt:	Background: We hypothesized that the time to successful fibreoptic tracheal intubation through the nasal route would be faster than the oral route for both experts and trainees in children <2 yr of age. Methods: One hundred children, 24 months and under in age, were randomized to an operator (expert or trainee), and route (nasal or oral) for fibreoptic tracheal intubation. Three separate times were then measured: (i) time to first glottic view, (ii) time to carinal view, and (iii) total time to successful tracheal intubation. The number of attempts made, manoeuvres needed to obtain an adequate laryngeal view, and manoeuvres for tracheal tube passage were also recorded. Results: Time to successful tracheal intubation was significantly faster for experts than trainees. There was no difference in the time to tracheal intubation between the nasal and oral routes for experts. In trainees, intubation times were shorter for the nasal route-median (inter-quartile range) time (s) to carinal view was 35 (27-63) for the nasal route vs 59 (38-94) for the oral route (P=0.03), and the median time to successful tracheal intubation were 62 (49-122) vs 117 (61-224), P=0.05, for the nasal and oral routes, respectively. For trainees, the oral route required a greater number of airway manoeuvres for adequate laryngeal views and passage of the tracheal tube compared with the nasal route. Conclusions: For clinicians with less experience in using paediatric bronchoscopes, fibreoptic tracheal intubation through the nasal route may be a more straightforward process than the oral route in children <2 yr of age. Clinical Trial Registration: NCT02029300 (www.clinicaltrials.gov). (© The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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