Abstract：
BACKGROUND: We investigated how syndromic versus nonsyndromic forms of micrognathia impacted difficult intubation outcomes in children. Primary outcome was the first-attempt success rate of tracheal intubation, secondary outcomes were number of intubation attempts and complications. We hypothesized that syndromic micrognathia would be associated with lower first-attempt success rate.
METHODS: In micrognathic patients enrolled in the Pediatric Difficult Intubation Registry (08/2012-03/2019) we retrospectively compared demographic and clinical characteristics between children with nonsyndromic and syndromic micrognathia using standardized mean differences (SMD) and assessed the association of the presence of syndrome with the primary and secondary outcomes using propensity score matching analysis with and without matching for airway assessment findings.
RESULTS: Nonsyndromic patients (628) were less likely to have additional airway abnormalities. Syndromic patients (216) were less likely to have unanticipated difficult intubation (2% vs. 20%, SMD 0.59). First-attempt success rates of intubation were: 38% in the syndromic versus 34% in the nonsyndromic group (odds ratio [OR] 1.18; 95% confidence intervals [95% CI] 0.74, 1.89; p = .478), and 37% versus 37% (OR 0.99; 95% CI 0.66, 1.48; p = .959). Median number of intubation attempts were 2 (interquartile range [IQR]: 1, 3; range: 1, 8) versus 2 (IQR: 1, 3; range 1, 12) (median regression coefficient = 0; 95% CI: -0.7, 0.7; p = .999) and 2 (IQR: 1, 3; range: 1, 12) versus 2 (IQR: 1, 3; range 1, 8) (median regression coefficient = 0; 95% CI: -0.5, 0.5; p = .999). Complication rates were 14% versus 22% (OR 0.6; 95% CI 0.34, 1.04; p = .07) and 16% versus 21% (OR 0.71; 95% CI 0.43, 1.17; p = .185).
CONCLUSIONS: Presence of syndrome was not associated with lower first-attempt success rate on intubation, number of intubation attempts, or complication rate among micrognathic patients difficult to intubate, despite more associated craniofacial abnormalities. Nonsyndromic patients were more likely to have unanticipated difficult intubations, first attempt with direct laryngoscopy.
METHODS: In micrognathic patients enrolled in the Pediatric Difficult Intubation Registry (08/2012-03/2019) we retrospectively compared demographic and clinical characteristics between children with nonsyndromic and syndromic micrognathia using standardized mean differences (SMD) and assessed the association of the presence of syndrome with the primary and secondary outcomes using propensity score matching analysis with and without matching for airway assessment findings.
RESULTS: Nonsyndromic patients (628) were less likely to have additional airway abnormalities. Syndromic patients (216) were less likely to have unanticipated difficult intubation (2% vs. 20%, SMD 0.59). First-attempt success rates of intubation were: 38% in the syndromic versus 34% in the nonsyndromic group (odds ratio [OR] 1.18; 95% confidence intervals [95% CI] 0.74, 1.89; p = .478), and 37% versus 37% (OR 0.99; 95% CI 0.66, 1.48; p = .959). Median number of intubation attempts were 2 (interquartile range [IQR]: 1, 3; range: 1, 8) versus 2 (IQR: 1, 3; range 1, 12) (median regression coefficient = 0; 95% CI: -0.7, 0.7; p = .999) and 2 (IQR: 1, 3; range: 1, 12) versus 2 (IQR: 1, 3; range 1, 8) (median regression coefficient = 0; 95% CI: -0.5, 0.5; p = .999). Complication rates were 14% versus 22% (OR 0.6; 95% CI 0.34, 1.04; p = .07) and 16% versus 21% (OR 0.71; 95% CI 0.43, 1.17; p = .185).
CONCLUSIONS: Presence of syndrome was not associated with lower first-attempt success rate on intubation, number of intubation attempts, or complication rate among micrognathic patients difficult to intubate, despite more associated craniofacial abnormalities. Nonsyndromic patients were more likely to have unanticipated difficult intubations, first attempt with direct laryngoscopy.
摘要：
背景：我们研究了综合征型和非综合征型的小颌畸形如何影响儿童困难的插管结局。主要结果是气管插管的首次尝试成功率，次要结局是插管尝试次数和并发症.我们假设综合征性小颌畸形与较低的首次尝试成功率有关。
方法：在儿科困难插管登记处（08/2012-03/2019）的微颌患者中，我们使用标准化平均差异（SMD）回顾性比较了非综合征性和综合征性微颌病患者之间的人口统计学和临床特征，并使用倾向评分匹配分析评估结果与气道评估结果的匹配，评估了综合征的存在与主要和次要结局的关联。
结果：非综合征患者（628）不太可能有额外的气道异常。综合征患者（216）不太可能出现意外困难的插管（2％vs.20%,SMD0.59）。首次插管成功率为：综合征组38％，非综合征组34％（比值比[OR]1.18；95％置信区间[95％CI]0.74，1.89；p=0.478），和37%对37%（OR0.99；95%CI0.66，1.48；p=.959）。插管尝试的中位数为2（四分位间距[IQR]：1，3；范围：1，8）对2（IQR：1，3；范围1，12）（中位数回归系数=0；95％CI：-0.7，0.7；p=.999）和2（IQR：1，3；范围：1，12）对2（IQR：1，3；范围：999；范围1，8）；p=0并发症发生率分别为14%对22%(OR0.6;95%CI0.34,1.04;p=.07)和16%对21%(OR0.71;95%CI0.43,1.17;p=.185)。
结论：综合征的存在与插管的首次尝试成功率较低无关，插管尝试次数,或难以插管的小颌患者的并发症发生率，尽管更多相关的颅面异常。非综合征患者更有可能出现意想不到的困难插管，首次尝试直接喉镜检查。
方法：在儿科困难插管登记处（08/2012-03/2019）的微颌患者中，我们使用标准化平均差异（SMD）回顾性比较了非综合征性和综合征性微颌病患者之间的人口统计学和临床特征，并使用倾向评分匹配分析评估结果与气道评估结果的匹配，评估了综合征的存在与主要和次要结局的关联。
结果：非综合征患者（628）不太可能有额外的气道异常。综合征患者（216）不太可能出现意外困难的插管（2％vs.20%,SMD0.59）。首次插管成功率为：综合征组38％，非综合征组34％（比值比[OR]1.18；95％置信区间[95％CI]0.74，1.89；p=0.478），和37%对37%（OR0.99；95%CI0.66，1.48；p=.959）。插管尝试的中位数为2（四分位间距[IQR]：1，3；范围：1，8）对2（IQR：1，3；范围1，12）（中位数回归系数=0；95％CI：-0.7，0.7；p=.999）和2（IQR：1，3；范围：1，12）对2（IQR：1，3；范围：999；范围1，8）；p=0并发症发生率分别为14%对22%(OR0.6;95%CI0.34,1.04;p=.07)和16%对21%(OR0.71;95%CI0.43,1.17;p=.185)。
结论：综合征的存在与插管的首次尝试成功率较低无关，插管尝试次数,或难以插管的小颌患者的并发症发生率，尽管更多相关的颅面异常。非综合征患者更有可能出现意想不到的困难插管，首次尝试直接喉镜检查。
