• Jocelyn R Grunwell, Pradip P Kamat, Michael Miksa, Ashwin Krishna, Karen Walson, Dennis Simon, Conrad Krawiec, Ryan Breuer, Jan Hau Lee, Eleanor Gradidge, Keiko Tarquinio, Asha Shenoi, Justine Shults, Vinay Nadkarni, Akira Nishisaki, and National Emergency Airway Registry for Children (NEAR4KIDS) and the Pediatric Acute Lung Injury and Sepsis (PALISI) Network.
• 1Division of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta at Egleston, Emory University School of Medicine, Atlanta, GA. 2Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY. 3Division of Critical Care Medicine, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky School of Medicine, Lexington, KY. 4Division of Critical Care Medicine, Department of Pediatrics, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA. 5Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Pittsburgh, Pittsburgh, PA. 6Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine, Hershey, PA. 7Division of Critical Care Medicine, Department of Pediatrics, Women and Children's Hospital of Buffalo, Buffalo, NY. 8Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore. 9Division of Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ. 10Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 11Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA.
• Pediatr Crit Care Me. 2017 Aug 1; 18 (8): 741749741-749.

ObjectiveVideo (indirect) laryngoscopy is used as a primary tracheal intubation device for difficult airways in emergency departments and in adult ICUs. The use and outcomes of video laryngoscopy compared with direct laryngoscopy has not been quantified in PICUs or cardiac ICUs.DesignRetrospective review of prospectively collected observational data from a multicenter tracheal intubation database (National Emergency Airway Registry for Children) from July 2010 to June 2015.SettingThirty-six PICUs/cardiac ICUs across the United States, Canada, Japan, New Zealand, and Singapore.PatientsAny patient admitted to a PICU or a pediatric cardiac ICU and undergoing tracheal intubation.InterventionsUse of direct laryngoscopy versus video laryngoscopy for tracheal intubation.Measurements And Main ResultsThere were 8,875 tracheal intubations reported in the National Emergency Airway Registry for Children database, including 7,947 (89.5%) tracheal intubations performed using direct laryngoscopy and 928 (10.5%) tracheal intubations performed using video laryngoscopy. Wide variability in video laryngoscopy use exists across PICUs (median, 2.6%; range, 0-55%). Video laryngoscopy was more often used in older children (p < 0.001), in children with history of a difficult airway (p = 0.01), in children intubated for ventilatory failure (p < 0.001), and to facilitate the completion of an elective procedure (p = 0.048). After adjusting for patient-level covariates, a secular trend, and site-level variance, the use of video laryngoscopy significantly increased over a 5-year period compared with fiscal year 2011 (odds ratio, 6.7; 95% CI, 1.7-26.8 for fiscal year 2014 and odds ratio, 11.2; 95% CI, 3.2-38.9 for fiscal year 2015). The use of video laryngoscopy was independently associated with a lower occurrence of tracheal intubation adverse events (adjusted odds ratio, 0.57; 95% CI, 0.42-0.77; p < 0.001) but not with a lower occurrence of severe tracheal intubation adverse events (adjusted odds ratio, 0.86; 95% CI, 0.56-1.32; p = 0.49) or fewer multiple attempts at endotracheal intubation (adjusted odds ratio, 0.93; 95% CI, 0.71-1.22; p = 0.59).ConclusionsUsing National Emergency Airway Registry for Children data, we described patient-centered adverse outcomes associated with video laryngoscopy compared with direct laryngoscopy for tracheal intubation in the largest reported international cohort of children to date. Data from this study may be used to design sufficiently powered prospective studies comparing patient-centered outcomes for video laryngoscopy versus direct laryngoscopy during endotracheal intubation.

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