Clinical Impact of External Laryngeal Manipulation during Laryngoscopy on Tracheal Intubation Success in Critically Ill Children

Taiki Kojima, Elizabeth K. Laverriere, Erin B. Owen, Ilana Harwayne-Gidansky, Asha N. Shenoi, Natalie Napolitano, Kyle J. Rehder, Michelle A. Adu-Darko, Sholeen T. Nett, Debbie Spear, Keith Meyer, John S. Giuliano, Keiko M. Tarquinio, Ronald C. Sanders, Jan Hau Lee, Dennis W. Simon, Paula Vanderford, Anthony Y. Lee, Calvin A. Brown, Peter W. SkippenRyan K. Breuer, Iris Toedt-Pingel, Simon J. Parsons, Eleanor A. Gradidge, Lily B. Glater, Kathleen Culver, Simon Li, Lee A. Polikoff, Joy D. Howell, Gabrielle Nuthall, Gokul K. Bysani, Ana L. Graciano, Guillaume Emeriaud, Osamu Saito, Alberto Orioles, Karen Walson, Philipp Jung, Awni M. Al-Subu, Takanari Ikeyama, Rakshay Shetty, Kathleen M. Yoder, Vinay M. Nadkarni, Akira Nishisaki

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: External laryngeal manipulation is a commonly used maneuver to improve visualization of the glottis during tracheal intubation in children. However, the effectiveness to improve tracheal intubation attempt success rate in the nonanesthesia setting is not clear. The study objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in PICUs. Design: A retrospective observational study using a multicenter emergency airway quality improvement registry. Setting: Thirty-five PICUs within general and children's hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). Patients: Critically ill children (< 18 years) undergoing initial tracheal intubation with direct laryngoscopy in PICUs between July 1, 2010, and December 31, 2015. Measurements and Main Results: Propensity score-matched analysis was performed to evaluate the association between external laryngeal manipulation and initial attempt success while adjusting for underlying differences in patient and clinical care factors: age, obesity, tracheal intubation indications, difficult airway features, provider training level, and neuromuscular blockade use. External laryngeal manipulation was defined as any external force to the neck during laryngoscopy. Of the 7,825 tracheal intubations, the initial tracheal intubation attempt was successful in 1,935/3,274 intubations (59%) with external laryngeal manipulation and 3,086/4,551 (68%) without external laryngeal manipulation (unadjusted odds ratio, 0.69; 95% CI, 0.62-0.75; p < 0.001). In propensity score-matched analysis, external laryngeal manipulation remained associated with lower initial tracheal intubation attempt success (adjusted odds ratio, 0.93; 95% CI, 0.90-0.95; p < 0.001). Conclusions: External laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. The indiscriminate use of external laryngeal manipulation cannot be recommended.

Original languageEnglish (US)
Pages (from-to)106-114
Number of pages9
JournalPediatric Critical Care Medicine
Volume19
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Laryngoscopy
Intubation
Critical Illness
Propensity Score
Odds Ratio
Glottis
Neuromuscular Blockade
Age Factors
Singapore
Quality Improvement
New Zealand
General Hospitals
Canada
Observational Studies
Registries
Patient Care
Japan
Emergencies
Neck
Retrospective Studies

Keywords

  • difficult airway
  • endotracheal intubation
  • external laryngeal manipulation
  • laryngoscopy
  • pediatric intensive care unit

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Kojima, T., Laverriere, E. K., Owen, E. B., Harwayne-Gidansky, I., Shenoi, A. N., Napolitano, N., ... Nishisaki, A. (2018). Clinical Impact of External Laryngeal Manipulation during Laryngoscopy on Tracheal Intubation Success in Critically Ill Children. Pediatric Critical Care Medicine, 19(2), 106-114. https://doi.org/10.1097/PCC.0000000000001373

Clinical Impact of External Laryngeal Manipulation during Laryngoscopy on Tracheal Intubation Success in Critically Ill Children. / Kojima, Taiki; Laverriere, Elizabeth K.; Owen, Erin B.; Harwayne-Gidansky, Ilana; Shenoi, Asha N.; Napolitano, Natalie; Rehder, Kyle J.; Adu-Darko, Michelle A.; Nett, Sholeen T.; Spear, Debbie; Meyer, Keith; Giuliano, John S.; Tarquinio, Keiko M.; Sanders, Ronald C.; Lee, Jan Hau; Simon, Dennis W.; Vanderford, Paula; Lee, Anthony Y.; Brown, Calvin A.; Skippen, Peter W.; Breuer, Ryan K.; Toedt-Pingel, Iris; Parsons, Simon J.; Gradidge, Eleanor A.; Glater, Lily B.; Culver, Kathleen; Li, Simon; Polikoff, Lee A.; Howell, Joy D.; Nuthall, Gabrielle; Bysani, Gokul K.; Graciano, Ana L.; Emeriaud, Guillaume; Saito, Osamu; Orioles, Alberto; Walson, Karen; Jung, Philipp; Al-Subu, Awni M.; Ikeyama, Takanari; Shetty, Rakshay; Yoder, Kathleen M.; Nadkarni, Vinay M.; Nishisaki, Akira.

In: Pediatric Critical Care Medicine, Vol. 19, No. 2, 01.02.2018, p. 106-114.

Research output: Contribution to journalArticle

Kojima, T, Laverriere, EK, Owen, EB, Harwayne-Gidansky, I, Shenoi, AN, Napolitano, N, Rehder, KJ, Adu-Darko, MA, Nett, ST, Spear, D, Meyer, K, Giuliano, JS, Tarquinio, KM, Sanders, RC, Lee, JH, Simon, DW, Vanderford, P, Lee, AY, Brown, CA, Skippen, PW, Breuer, RK, Toedt-Pingel, I, Parsons, SJ, Gradidge, EA, Glater, LB, Culver, K, Li, S, Polikoff, LA, Howell, JD, Nuthall, G, Bysani, GK, Graciano, AL, Emeriaud, G, Saito, O, Orioles, A, Walson, K, Jung, P, Al-Subu, AM, Ikeyama, T, Shetty, R, Yoder, KM, Nadkarni, VM & Nishisaki, A 2018, 'Clinical Impact of External Laryngeal Manipulation during Laryngoscopy on Tracheal Intubation Success in Critically Ill Children', Pediatric Critical Care Medicine, vol. 19, no. 2, pp. 106-114. https://doi.org/10.1097/PCC.0000000000001373
Kojima, Taiki ; Laverriere, Elizabeth K. ; Owen, Erin B. ; Harwayne-Gidansky, Ilana ; Shenoi, Asha N. ; Napolitano, Natalie ; Rehder, Kyle J. ; Adu-Darko, Michelle A. ; Nett, Sholeen T. ; Spear, Debbie ; Meyer, Keith ; Giuliano, John S. ; Tarquinio, Keiko M. ; Sanders, Ronald C. ; Lee, Jan Hau ; Simon, Dennis W. ; Vanderford, Paula ; Lee, Anthony Y. ; Brown, Calvin A. ; Skippen, Peter W. ; Breuer, Ryan K. ; Toedt-Pingel, Iris ; Parsons, Simon J. ; Gradidge, Eleanor A. ; Glater, Lily B. ; Culver, Kathleen ; Li, Simon ; Polikoff, Lee A. ; Howell, Joy D. ; Nuthall, Gabrielle ; Bysani, Gokul K. ; Graciano, Ana L. ; Emeriaud, Guillaume ; Saito, Osamu ; Orioles, Alberto ; Walson, Karen ; Jung, Philipp ; Al-Subu, Awni M. ; Ikeyama, Takanari ; Shetty, Rakshay ; Yoder, Kathleen M. ; Nadkarni, Vinay M. ; Nishisaki, Akira. / Clinical Impact of External Laryngeal Manipulation during Laryngoscopy on Tracheal Intubation Success in Critically Ill Children. In: Pediatric Critical Care Medicine. 2018 ; Vol. 19, No. 2. pp. 106-114.
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T1 - Clinical Impact of External Laryngeal Manipulation during Laryngoscopy on Tracheal Intubation Success in Critically Ill Children

AU - Kojima, Taiki

AU - Laverriere, Elizabeth K.

AU - Owen, Erin B.

AU - Harwayne-Gidansky, Ilana

AU - Shenoi, Asha N.

AU - Napolitano, Natalie

AU - Rehder, Kyle J.

AU - Adu-Darko, Michelle A.

AU - Nett, Sholeen T.

AU - Spear, Debbie

AU - Meyer, Keith

AU - Giuliano, John S.

AU - Tarquinio, Keiko M.

AU - Sanders, Ronald C.

AU - Lee, Jan Hau

AU - Simon, Dennis W.

AU - Vanderford, Paula

AU - Lee, Anthony Y.

AU - Brown, Calvin A.

AU - Skippen, Peter W.

AU - Breuer, Ryan K.

AU - Toedt-Pingel, Iris

AU - Parsons, Simon J.

AU - Gradidge, Eleanor A.

AU - Glater, Lily B.

AU - Culver, Kathleen

AU - Li, Simon

AU - Polikoff, Lee A.

AU - Howell, Joy D.

AU - Nuthall, Gabrielle

AU - Bysani, Gokul K.

AU - Graciano, Ana L.

AU - Emeriaud, Guillaume

AU - Saito, Osamu

AU - Orioles, Alberto

AU - Walson, Karen

AU - Jung, Philipp

AU - Al-Subu, Awni M.

AU - Ikeyama, Takanari

AU - Shetty, Rakshay

AU - Yoder, Kathleen M.

AU - Nadkarni, Vinay M.

AU - Nishisaki, Akira

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objectives: External laryngeal manipulation is a commonly used maneuver to improve visualization of the glottis during tracheal intubation in children. However, the effectiveness to improve tracheal intubation attempt success rate in the nonanesthesia setting is not clear. The study objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in PICUs. Design: A retrospective observational study using a multicenter emergency airway quality improvement registry. Setting: Thirty-five PICUs within general and children's hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). Patients: Critically ill children (< 18 years) undergoing initial tracheal intubation with direct laryngoscopy in PICUs between July 1, 2010, and December 31, 2015. Measurements and Main Results: Propensity score-matched analysis was performed to evaluate the association between external laryngeal manipulation and initial attempt success while adjusting for underlying differences in patient and clinical care factors: age, obesity, tracheal intubation indications, difficult airway features, provider training level, and neuromuscular blockade use. External laryngeal manipulation was defined as any external force to the neck during laryngoscopy. Of the 7,825 tracheal intubations, the initial tracheal intubation attempt was successful in 1,935/3,274 intubations (59%) with external laryngeal manipulation and 3,086/4,551 (68%) without external laryngeal manipulation (unadjusted odds ratio, 0.69; 95% CI, 0.62-0.75; p < 0.001). In propensity score-matched analysis, external laryngeal manipulation remained associated with lower initial tracheal intubation attempt success (adjusted odds ratio, 0.93; 95% CI, 0.90-0.95; p < 0.001). Conclusions: External laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. The indiscriminate use of external laryngeal manipulation cannot be recommended.

AB - Objectives: External laryngeal manipulation is a commonly used maneuver to improve visualization of the glottis during tracheal intubation in children. However, the effectiveness to improve tracheal intubation attempt success rate in the nonanesthesia setting is not clear. The study objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in PICUs. Design: A retrospective observational study using a multicenter emergency airway quality improvement registry. Setting: Thirty-five PICUs within general and children's hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand). Patients: Critically ill children (< 18 years) undergoing initial tracheal intubation with direct laryngoscopy in PICUs between July 1, 2010, and December 31, 2015. Measurements and Main Results: Propensity score-matched analysis was performed to evaluate the association between external laryngeal manipulation and initial attempt success while adjusting for underlying differences in patient and clinical care factors: age, obesity, tracheal intubation indications, difficult airway features, provider training level, and neuromuscular blockade use. External laryngeal manipulation was defined as any external force to the neck during laryngoscopy. Of the 7,825 tracheal intubations, the initial tracheal intubation attempt was successful in 1,935/3,274 intubations (59%) with external laryngeal manipulation and 3,086/4,551 (68%) without external laryngeal manipulation (unadjusted odds ratio, 0.69; 95% CI, 0.62-0.75; p < 0.001). In propensity score-matched analysis, external laryngeal manipulation remained associated with lower initial tracheal intubation attempt success (adjusted odds ratio, 0.93; 95% CI, 0.90-0.95; p < 0.001). Conclusions: External laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. The indiscriminate use of external laryngeal manipulation cannot be recommended.

KW - difficult airway

KW - endotracheal intubation

KW - external laryngeal manipulation

KW - laryngoscopy

KW - pediatric intensive care unit

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