Advertisement

European Journal of Pediatrics

, Volume 178, Issue 7, pp 1105–1111 | Cite as

Comparative evaluation of Airtraq™ and GlideScope® videolaryngoscopes for difficult pediatric intubation in a Pierre Robin manikin

  • Neel DesaiEmail author
  • Mae Johnson
  • Kat Priddis
  • Samiran Ray
  • Linda Chigaru
Original Article

Abstract

Airway management in children is associated with anatomical and physiological challenges compared with adults. Pierre Robin sequence (PRS) is a condition characterized by micrognathia, glossoptosis, and cleft palate and related to a difficult airway. Both the Airtraq™ and GlideScope® have never been previously directly compared in PRS. Our aim was to evaluate the performance of these two airway devices in a PRS manikin for ethical and practical reasons. Between April and July 2017, 26, pediatric intensive care clinical fellows or trainees from a tertiary pediatric center were recruited to participate. In this prospective and randomized crossover trial, all participants first set up the Airtraq™ and the GlideScope® and then used these videolaryngoscopes to intubate an AirSim® PRS manikin. Our primary outcome measure was the duration of the successful intubation attempt. Duration of the successful intubation attempt was 18.1 (14.2–34.9 [10.2–51.3]) s for the Airtraq™ compared to 31.1 (18.7–55.6 [6.2–119]) s for the GlideScope® (p = 0.045). Setup time was 50.0 ± 6.9 s for the Airtraq™ and 27.8 ± 8.6 s for the GlideScope® (p < 0.001).

Conclusion: Even though setup time was longer, the characteristics of intubation performance were superior with the Airtraq™ relative to the GlideScope® in an AirSim® PRS manikin.

What is Known:

Several case reports have described the successful use of Airtraq™ to intubate children with Pierre Robin sequence.

The GlideScope® has demonstrated similar rates of first-attempt successful intubation to flexible fiberoptic bronchoscopy in a Pierre Robin sequence manikin.

What is New:

In the hands of pediatric non-airway specialists, the characteristics of intubation performance, including the duration of the successful intubation attempt, are superior with the Airtraq™ compared with the GlideScope® in a Pierre Robin sequence manikin.

Setup time for the Airtraq™ is, however, longer relative to that for the GlideScope®.

Keywords

Intubation Laryngoscopy Manikins Pediatrics Pierre Robin syndrome 

Abbreviations

DL

Direct laryngoscopy

FFB

Flexible fiberoptic bronchoscopy

IQR

Interquartile range

NEAR4KIDS

National Emergency Airway Registry for Children

NHS

National Health Service

POGO

Percentage of glottic opening

PRS

Pierre Robin sequence

TTI

Time to intubation

SD

Standard deviation

VL

Videolaryngoscope

Notes

Acknowledgements

The authors would like to thank Dr. Emma Borrows, Consultant in Paediatric Critical Care at the Great Ormond Street Hospital for Children NHS Foundation Trust, for her assistance in the capture of photographs used in this manuscript. We wish to thank all the participants for their involvement in the study.

Authors’ contributions

ND contributed to the design of the study, data collection, statistical analysis, and drafting and reviewing of the manuscript. MJ contributed to the data collection and drafting of the manuscript. KP contributed to the data collection. SR contributed to the statistical analysis. LC contributed to the design of the study, statistical analysis, and reviewing of the manuscript.

Compliance with ethical statements

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

No formal ethical approval needed after consideration by the Joint Research and Development Office, and it was registered as a service evaluation.

Informed consent

Written informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Arslan ZI, Turna C, Gumus NE, Toker K, Solak M (2016) Intubation of a paediatric manikin in tongue oedema and face-to-face simulations by novice personnel: a comparison of Glidescope, Airtraq and direct laryngoscopy. Turk J Anaesthesiol Reanim 44:71–75CrossRefGoogle Scholar
  2. 2.
    Brambrink AM, Braun U (2005) Airway management in infants and children. Best Pract Res Clin Anaesthesiol 19:675–697CrossRefGoogle Scholar
  3. 3.
    Desai N, Abdelrazeq S, Chigaru L et al (2018) Airtraq intubation in a newborn with a difficult airway secondary to Pierre Robin sequence. Anaesthesia 73:62Google Scholar
  4. 4.
    Dobby N, Black A, Ong KB (2012) Airtraq vs Glidescope – airway management of a pediatric population with a documented difficult airway; Cormack and Lehane Grade III or IV. Pediatr Anesth 22:921CrossRefGoogle Scholar
  5. 5.
    Fiadjoe JE, Gurnaney H, Dalesio N, Sussman E, Zhao H, Zhang X, Stricker PA (2012) A prospective randomized equivalence trial of the GlideScope Cobalt video laryngoscope to traditional direct laryngoscopy in neonates and infants. Anesthesiology 116:622–628CrossRefGoogle Scholar
  6. 6.
    Fiadjoe JE, Hirschfeld M, Wu S, Markley J, Gurnaney H, Jawad AF, Stricker P, Kilbaugh T, Ross P, Kovatsis P (2015) A randomized multi-institutional crossover comparison of the GlideScope Cobalt Video laryngoscope to the flexible fiberoptic bronchoscope in a Pierre Robin manikin. Pediatr Anesth 25:801–806CrossRefGoogle Scholar
  7. 7.
    Fonte M, Oulego-Erroz I, Nadkarni L, Sánchez-Santos L, Iglesias-Vásquez A, Rodríguez-Núñez A (2011) A randomized comparison of the GlideScope videolaryngoscope to standard laryngoscopy for intubation by pediatric residents in simulated easy and difficult infant airway scenarios. Pediatr Emerg Care 27:398–402CrossRefGoogle Scholar
  8. 8.
    Grunwell JR, Kamat PP, Miksa M, Krishna A, Walson K, Simon D, Krawiec C, Breuer R, Lee JH, Gradidge E, Tarquinio K, Shenoi A, Shults J, Nadkarni V, Nishisaki A, National Emergency Airway Registry for Children (NEAR4KIDS) and the Pediatric Acute Lung Injury and Sepsis (PALISI) Network (2017) Trends and outcomes of video laryngoscope use across PICUs. Pediatr Crit Care Med 18:741–749CrossRefGoogle Scholar
  9. 9.
    Holm-Knudsen RJ, Rasmussen LS (2009) Paediatric airway management: basic aspects. Acta Anaesthesiol Scand 53:1–9CrossRefGoogle Scholar
  10. 10.
    Isada T, Miwa T, Hiroki K et al (2005) The management of the difficult pediatric airway. Masui 54:490–495Google Scholar
  11. 11.
    Jackson KM, Cook TM (2007) Evaluation of four airway training manikins as patient simulators for the insertion of eight types of supraglottic airway devices. Anaesthesia 62:388–393CrossRefGoogle Scholar
  12. 12.
    Kleine-Brueggeney M, Greif R, Schoettker P, Savoldelli GL, Nabecker S, Theiler LG (2016) Evaluation of six videolaryngoscopes in 720 patients with a simulated difficult airway: a multicentre randomized controlled trial. Br J Anaesth 116:670–679CrossRefGoogle Scholar
  13. 13.
    Knipe M, Armstrong J (2015) Comparison of the GlideScope and Airtraq video-laryngoscopes with direct laryngoscopy in paediatric difficult airways by inexperienced users: a manikin study. Anaesthesia 70:31Google Scholar
  14. 14.
    Koerner IP, Brambrink AM (2005) Fiberoptic techniques. Best Pract Res Clin Anaesthesiol 19:611–621CrossRefGoogle Scholar
  15. 15.
    Lee JH, Turner DA, Kamat P (2016) The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study. BMC Pediatr 16:58CrossRefGoogle Scholar
  16. 16.
    Levitan RM, Ochroch EA, Kush S et al (1998) Assessment of airway visualization: validation of the percentage of glottic opening (POGO) scale. Acad Emerg Med 5:919–923CrossRefGoogle Scholar
  17. 17.
    Li S, Hsieh TC, Rehder KJ (2018) Frequency of desaturation and association with hemodynamic adverse events during tracheal intubations in PICUs. Pediatr Crit Care Med 19:e41–e50CrossRefGoogle Scholar
  18. 18.
    Maharaj CH, Costello JF, Higgins BD, Harte BH, Laffey JG (2006) Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope. Anaesthesia 61:671–677CrossRefGoogle Scholar
  19. 19.
    Nargozian C (2004) The airway in patients with craniofacial abnormalities. Paediatr Anaesth 14:53–59CrossRefGoogle Scholar
  20. 20.
    Orliaguet GA, Blot RM, Bourdaud N, Egan M, Dogaru E, Salvi N, Gall O, Carli P (2013) Endotracheal intubation with the GlideScope®, the Airtraq®, the McGrath® videolaryngoscope and direct laryngoscopy: a comparative study on an infant manikin. Ann Fr Anesth Reanim 32:844–849CrossRefGoogle Scholar
  21. 21.
    Owada G, Mihara T, Inagawa G, Asakura A, Goto T, Ka K (2017) A comparison of the Airtraq, McGrath, and Macintosh laryngoscopes for difficult paediatric intubation: a manikin study. PLoS One 12:e0171889.  https://doi.org/10.1371/journal.pone.0171889 CrossRefGoogle Scholar
  22. 22.
    Parker MM, Nuthall G, Brown C III et al (2017) Relationship between adverse tracheal intubation associated events and PICU outcomes. Pediatr Crit Care Med 18:310–318CrossRefGoogle Scholar
  23. 23.
    Rodriguez-Nunez A, Oulego-Erroz I, Perez-Gay L, Cortinas-Diaz J (2010) Comparison of the GlideScope videolaryngoscope to the standard Macintosh for intubation by pediatric residents in simulated child airway scenarios. Pediatr Emerg Care 26:726–729CrossRefGoogle Scholar
  24. 24.
    Schebesta K, Hupfl M, Rossler B et al (2012) Degrees of reality: airway anatomy of high-fidelity human patient simulators and airway trainers. Anesthesiology 116:1204–1209CrossRefGoogle Scholar
  25. 25.
    Shah A, Patwa A, Patwa A (2016) Use of Airtraq optical laryngoscope for the intubation in Pierre Robin sequence in a teenage child. Indian J Anaesth 60:295–297CrossRefGoogle Scholar
  26. 26.
    Smereka J (2016) Comparison of Airtraq and Miller laryngoscopes for intubation in patients with inline manual neck stabilization. Am J Emerg Med 34:1721CrossRefGoogle Scholar
  27. 27.
    Turkstra TP, Harle CC, Armstrong KP, Armstrong PM, Cherry RA, Hoogstra J, Jones PM (2007) The GlideScope-specific rigid stylet and standard malleable stylet are equally effective for GlideScope use. Can J Anaesth 54:891–896CrossRefGoogle Scholar
  28. 28.
    Vlatten A, Soder C (2009) Airtraq optical laryngoscope intubation in a 5-month-old infant with a difficult airway because of Robin Sequence. Paediatr Anaesth 19:699–700CrossRefGoogle Scholar
  29. 29.
    Vlatten A, Litz S, MacManus B, Launcelott S, Soder C (2012) A comparison of the GlideScope video laryngoscope and standard direct laryngoscopy in children with immobilized cervical spine. Pediatr Emerg Care 28:1317–1320CrossRefGoogle Scholar
  30. 30.
    White M, Weale N, Nolan J et al (2009) Comparison of the cobalt Glidescope video laryngoscope with conventional laryngoscopy in simulated normal and difficult infant airways. Pediatr Anesth 19:1108–1112CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of AnaestheticsGuy’s and St Thomas’ NHS Foundation TrustLondonUK
  2. 2.Children’s Acute Transport ServiceLondonUK
  3. 3.Department of AnaestheticsGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
  4. 4.Respiratory, Critical Care and Anaesthesia SectionUniversity College London Great Ormond Street Institute of Child HealthLondonUK

Personalised recommendations