Supraglottic airway devices were linked to fewer respiratory events in children with reactive airways

Design

Multicentre retrospective registry cohort with propensity-score weighting

Population

4,878 children with airway hyperresponsiveness (3,005 intubated, 1,873 supraglottic airway)

Primary outcome

Respiratory adverse events during induction-phase airway management

Effect

Adjusted RR 0.41 (95% CI 0.19 to 0.62); severe desaturation aRR 0.47 (0.19 to 0.75)

A multicentre retrospective study in 12 tertiary hospitals in the Japan Paediatric Difficult Airway in Anaesthesia registry examined children under 18 having general anaesthesia with an active or recent upper respiratory infection, asthma exacerbation or household smoke exposure. Of 27,844 encounters, 4,878 were analysed: 3,005 tracheal intubations (61.6%) and 1,873 supraglottic airway placements (38.4%).

After propensity-based weighting, supraglottic airway use was associated with lower risks of respiratory adverse events (adjusted RR 0.41, 95% CI 0.19 to 0.62), airway management-related events (0.32, 0.19 to 0.45) and severe oxygen desaturation (0.47, 0.19 to 0.75).

The authors support considering a supraglottic device when clinically appropriate and acknowledge residual confounding. Children were not randomised, and operators may have chosen the device in children they judged lower risk. The procedure still decides whether a supraglottic device is suitable, since some surgery needs a tracheal tube.

• Consider a supraglottic device where the surgery allows, in children with recent respiratory infection or reactive airways.
• Adjusted risks of respiratory events and severe desaturation were all lower, but this was not randomised.
• Keep intubation for cases where airway protection or surgery require it.
• Record the reason for device choice to support local audit.

Why it matters

It gives a concrete, device-level option in a group of children where airway events are common.

Don't overread it

Retrospective and non-randomised; the choice of device may have tracked unmeasured risk.

The statistics, in plain English

An adjusted risk ratio of 0.41 means events were about 60% less frequent after statistical balancing of measured characteristics. Weighting cannot account for clinical judgement the registry did not record, such as how unwell the child looked.

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