Video Laryngoscopy for Pediatric Intubation

Primary Recommendations

The French Society of Anaesthesia and Intensive Care recommends using videolaryngoscopy as the first-line option for patients with anticipated difficult intubation but possible mask ventilation, or after failure of direct laryngoscopy, to increase the probability of successful intubation (Grade 2+) 1, 2, 3, 4, 5.
The American Academy of Pediatrics recommends using cuffed endotracheal tubes with cuff pressure ≤20 cm H2O to reduce re-intubation rates without increasing laryngeal complications 9.

A large multicentre prospective observational study including 1,053 intubations found significantly enhanced first-attempt success with videolaryngoscopy in pediatric intensive care settings 6, 7, 8.
Videolaryngoscopes should be used by trained practitioners in patients with difficult intubation criteria 1, 2, 3.

External laryngeal maneuvers are facilitated when using a videolaryngoscope with a remote screen because their effect is directly visible by the assistant 1, 2, 3.
When using a videolaryngoscope without a lateral channel, use a non-traumatic preformed guide to direct the tracheal tube toward the glottic aperture 1, 2, 3.

The American Society of Anesthesiologists recommends limiting direct laryngoscopy attempts to a maximum of 2 tries by the most senior practitioner present, with adequate depth of anesthesia, optimal head positioning, gastric decompression, and application of CPAP before each attempt 9.