Curtin University Homepage
  • Library
  • Help
    • Admin

    espace - Curtin’s institutional repository

    JavaScript is disabled for your browser. Some features of this site may not work without it.
    View Item 
    • espace Home
    • espace
    • Curtin Research Publications
    • View Item
    • espace Home
    • espace
    • Curtin Research Publications
    • View Item

    The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: a randomised controlled trial

    Access Status
    Fulltext not available
    Authors
    Drake-Brockman, T.
    Ramgolam, A.
    Zhang, Guicheng
    Hall, G.
    von Ungern-Sternberg, B.
    Date
    2017
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Drake-Brockman, T. and Ramgolam, A. and Zhang, G. and Hall, G. and von Ungern-Sternberg, B. 2017. The effect of endotracheal tubes versus laryngeal mask airways on perioperative respiratory adverse events in infants: a randomised controlled trial. The Lancet. 389 (10070): pp. 701-708.
    Source Title
    The Lancet
    DOI
    10.1016/S0140-6736(16)31719-6
    ISSN
    0140-6736
    School
    School of Public Health
    URI
    http://hdl.handle.net/20.500.11937/53439
    Collection
    • Curtin Research Publications
    Abstract

    Background: Perioperative respiratory adverse events (PRAE) are the most common critical incidents in paediatric anaesthesia and occur more often in infants. Use of laryngeal mask airways (LMAs) is associated with reduced PRAE compared with endotracheal tubes in older children (>1 year). We aimed to evaluate the effect of these devices on the incidence of PRAE in infants. Methods: We did a randomised controlled trial at the Princess Margaret Hospital for Children in Perth (WA, Australia) by recruiting infants (aged 0–12 months) undergoing general (with or without regional or local) anaesthesia with anticipated fentanyl dose 1 µg/kg or lower for minor elective surgery. We excluded patients contraindicated for LMA or endotracheal tube; who had known cardiac disease or airway or thoracic malformations; who were receiving midazolam premedication; who were undergoing airway, thoracic, or abdomen surgery at the time of participation; and if the parents did not speak English. Written parental or guardian consent was obtained before enrolment. Participants were randomly assigned (1:1), by computer-generated variable block randomisation, to receive an LMA (PRO-Breathe, Well Lead Medical Co Ltd, Panyu, China) or an endotracheal tube (Microcuff, Halyard Health Inc, Atlanta, GA, USA). Sealed randomisation envelopes were used to conceal device assignment. An interim analysis was planned once half the number of infants needed (145) had been recruited. The primary outcome was incidence of PRAE, assessed in the intention-to-treat population. The institutional ethics committee at the Princess Margaret Hospital for Children granted ethical approval (1786/EP). The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000250033). Findings: The trial began on July 8, 2010, and was ended early on May 7, 2015, after the interim analysis results met the study stopping rules. During this time, 239 infants were assessed and 181 eligible infants were randomly assigned to receive an LMA (n=85) or an endotracheal tube (n=95). Four infants were not included in the analysis (two due to cancelled procedures, one did not meet inclusion criteria, and one with missing dataset). In the intention-to-treat analysis, PRAE occurred in 50 (53%) infants in the endotracheal tube group and in 15 (18%) infants in the LMA group (risk ratio [RR] 2·94, 95% CI 1·79–4·83, p<0·0001). Laryngospasm and bronchospasm (major PRAE) were recorded in 18 (19%) infants in the endotracheal tube group and in three (4%) infants in the LMA group (RR 5·30, 95% CI 1·62–17·35, p=0·002). No deaths were reported. Interpretation In infants undergoing minor elective procedures, LMAs were associated with clinically significantly fewer PRAE and lower occurrence of major PRAE (laryngospasm and bronchospasm) than endotracheal tubes. This difference should be a consideration in airway device selection. Funding Princess Margaret Hospital Foundation, National Health and Australian Medical Research Council, Stan Perron Charitable Trust, and Callahan Estate.

    Related items

    Showing items related by title, author, creator and subject.

    • Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants
      Spittle, A.; Orton, J.; Anderson, P.; Boyd, Roslyn; Doyle, L. (2015)
      Background: Infants born preterm are at increased risk of developing cognitive and motor impairment compared with infants born at term. Early developmental interventions have been provided in the clinical setting with the ...
    • Early developmental intervention programmes post-hospital discharge to prevent motor and cognitive impairments in preterm infants
      Spittle, A.; Orton, J.; Anderson, P.; Boyd, Roslyn; Doyle, L. (2012)
      Background: Infants born preterm are at increased risk of developing cognitive and motor impairments compared with infants born at term. Early developmental interventions have been used in the clinical setting with the ...
    • Reducing the frequency of aspirating gastric tubes in patients enterally fed in the ICU: A randomised control trial
      Williams, T.; Leslie, Gavin; Mills, L.; Davies, H.; Leen, T.; Dobb, G. (2013)
      BACKGROUND: Enteral nutrition (EN) tolerance is monitored by aspirating stomach contents by syringe at prescribed intervals. No studies have been conducted to assess the most appropriate time interval for aspirating ...
    Advanced search

    Browse

    Communities & CollectionsIssue DateAuthorTitleSubjectDocument TypeThis CollectionIssue DateAuthorTitleSubjectDocument Type

    My Account

    Admin

    Statistics

    Most Popular ItemsStatistics by CountryMost Popular Authors

    Follow Curtin

    • 
    • 
    • 
    • 
    • 

    CRICOS Provider Code: 00301JABN: 99 143 842 569TEQSA: PRV12158

    Copyright | Disclaimer | Privacy statement | Accessibility

    Curtin would like to pay respect to the Aboriginal and Torres Strait Islander members of our community by acknowledging the traditional owners of the land on which the Perth campus is located, the Whadjuk people of the Nyungar Nation; and on our Kalgoorlie campus, the Wongutha people of the North-Eastern Goldfields.