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Airway management in paediatric anaesthesia in Europe—insights from APRICOT (Anaesthesia Practice In Children Observational Trial): a prospective multicentre observational study in 261 hospitals in Europe - 12/7/2018

Br J Anaesth 2018; 121: 66-75


Critical respiratory events are common in children in the peri-anaesthetic period and are caused by airway and ventilation management difficulties. These authors aimed to evaluate current European paediatric airway management practices and identify the incidence and potential consequences of difficult airway management.



The authors performed a secondary analysis of airway and ventilation management details of the European multicentre observational trial (Anaesthesia PRactice in Children Observational Trial, APRICOT) of children from birth to 15 years of age. The primary endpoint was the incidence of difficult airway management. Secondary endpoints were the associations between difficult airway management, known pre-existing respiratory risk factors and the occurrence of critical respiratory events.



Details for 31,024 anaesthetic procedures were available for analysis. Three or more tracheal intubation attempts were necessary in 120 children (0.9%) and in 40 children (0.4%) for supraglottic airways insertions. The incidence (95% confidence interval) for failed tracheal intubation and failed supraglottic airway insertions was 8/10 000 (0.08%; 0.03 to 0.13%) and 8.2/10 000 (0.08%; 0.03 to 0.14%) children, respectively. Difficulties in securing the airway increased the risk for a critical respiratory event for tracheal tube (2.1; 1.3 to 3.4) and supraglottic airway (4.3; 1.9 to 9.9) placement. History of pre-existing respiratory risk factors was significantly associated with critical respiratory events independently of the airway device used.



The authors conclude that airway management practices vary widely across Europe. They state that multiple airway device insertion attempts and pre-existing respiratory risk factors increase the likelihood of critical respiratory events in children and require further stratification during preoperative assessment and planning.

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