Development of a guideline for the management of the unanticipated difficult airway in pediatric practice.

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Clinical Guidelines
Authored By
Black AE, Flynn PE, Smith HL, Thomas ML, Wilkinson KA
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Pulmonology
Emergency Medicine
Surgery
Speciality
Surgery
Emergency Medicine
Pulmonology
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volume
25
ISSN
1460-9592
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ISSN
1460-9592
IS_Ebsco
true
Additional Info
["Black AE, Flynn PE, Smith HL, Thomas ML, Wilkinson KA","Association of Pediatric Anaesthetists of Great Britain and Ireland","Publisher: Arnette-Blackwell Country of Publication: France NLM ID: 9206575 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1460-9592 (Electronic) Linking ISSN: 11555645 NLM ISO Abbreviation: Paediatr Anaesth Subsets: MEDLINE","Practice Guideline; Journal Article; Research Support, Non-U.S. Gov't","2015-04-01","Paediatric anaesthesia [Paediatr Anaesth] 2015 Apr; Vol. 25 (4), pp. 346-62. Date of Electronic Publication: 2015 Feb 16.","English","1460-9592","Airway Management\/*methods , Intraoperative Complications\/*therapy, Adolescent ; Airway Management\/instrumentation ; Child ; Child, Preschool ; Consensus ; Delphi Technique ; Humans ; Infant ; Intubation, Intratracheal\/adverse effects ; Intubation, Intratracheal\/methods ; Laryngeal Masks\/adverse effects ; Oxygen\/blood ; Patient Positioning ; Stomach Diseases\/etiology ; Tracheostomy","Adolescent, Airway Management instrumentation, Child, Child, Preschool, Consensus, Delphi Technique, Humans, Infant, Intubation, Intratracheal adverse effects, Intubation, Intratracheal methods, Laryngeal Masks adverse effects, Oxygen blood, Patient Positioning, Stomach Diseases etiology, Tracheostomy, Airway Management methods, Intraoperative Complications therapy","Paediatric anaesthesia","25"]
Description
Background: Most airway problems in children are identified in advance; however, unanticipated difficulties can arise and may result in serious complications. Training for these sporadic events can be difficult. We identified the need for a structured guideline to improve clinical decision making in the acute situation and also to provide a guide for teaching.<br />Objective: Guidelines for airway management in adults are widely used; however, none have been previously devised for national use in children. We aimed to develop guidelines for the management of the unanticipated difficult pediatric airway for use by anesthetists working in the nonspecialist pediatric setting.<br />Method: We reviewed available guidelines used in individual hospitals. We also reviewed research into airway management in children and graded papers for the level of evidence according to agreed criteria. A Delphi panel comprising 27 independent consultant anesthetists considered the steps of the acute airway management guidelines to reach consensus on the best interventions to use and the order in which to use them. If following the literature review and Delphi feedback, there was insufficient evidence or lack of consensus, regarding inclusion of a particular point; this was reviewed by a Second Specialist Group comprising 10 pediatric anesthetists.<br />Results: Using the Delphi group's deliberations and feedback from the Second Specialist Group, we developed three guidelines for the acute airway management of children aged 1-8 years.<br />Conclusions: This paper provides the background, available evidence base, and justification for each step in the resultant guidelines and gives a rationale for their use.<br /> (© 2015 John Wiley & Sons Ltd.)
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