{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T02:10:10Z","timestamp":1743905410628,"version":"3.40.3"},"reference-count":12,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T00:00:00Z","timestamp":1721779200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background\/Aims<\/jats:title><jats:p>The pediatric Difficult Airway Consultation Service (pDACS) was created in 2017 to identify patients with potentially difficult airways and create airway management plans prior to airway management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consults were either nurse\u2010initiated, physician\u2010initiated, or both nurse\u2010and\u2010physician\u2010initiated and were examined for demographic and clinical factors. If a child had difficult airway risk factors, a consult note with airway management recommendations was completed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 419 consults from the 4\u2010year study period for analysis. Sixty\u2010one patients had chronic tracheostomies in place and thus, were analyzed separately. Of the remaining 358 consults, 50% (<jats:italic>n<\/jats:italic>\u2009=\u2009179) were nurse\u2010initiated, 30.2% (<jats:italic>n<\/jats:italic>\u2009=\u2009108) physician\u2010initiated, and 19.8% (<jats:italic>n<\/jats:italic>\u2009=\u200971) nurse\u2010and\u2010physician\u2010initiated consults. Differences in observed frequency of airway edema (difference, 6.3%; 95%CI 0.1%\u201312.5%; <jats:italic>p<\/jats:italic>\u2009=\u2009.04), cleft lip\/palate (difference, 8.1%; 95%CI 0.07%\u201316.3%, <jats:italic>p<\/jats:italic>\u2009=\u2009.04), craniofacial abnormalities (difference, 12.3%; 95%CI 1.9%\u201322.7%, <jats:italic>p<\/jats:italic>\u2009=\u2009.02), and trauma\/burn (difference, 6.5%; 95%CI 0.09%\u201312.8%, <jats:italic>p<\/jats:italic>\u2009=\u2009.04) were calculated. Observed frequencies were higher in physician\u2010initiated compared to nurse\u2010initiated consults. Airway edema was also more prevalent in dual nurse\u2010and\u2010physician\u2010initiated consults (difference, 8.7%; 95%CI 1.6%\u201315.8%; <jats:italic>p<\/jats:italic>\u2009=\u2009.01). Physician\u2010initiated consults were associated with a greater proportion of high\u2010risk difficult airways than nurse\u2010initiated consults (difference, 26.7%; 95%CI 14.0%\u201339.4%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Approximately 41.9% of patients at high\u2010risk for having a difficult airway were identified by nurse\u2010screening only.<\/jats:p><jats:p>Using bag\u2010valve\u2010mask was often the primary ventilation recommendation (89.3%, <jats:italic>n<\/jats:italic>\u2009=\u2009108) and supraglottic airway placement was the most common tertiary plan (74.2%, <jats:italic>n<\/jats:italic>\u2009=\u200983). Direct laryngoscopy (47.1%, <jats:italic>n<\/jats:italic>\u2009=\u200965) and videolaryngoscopy (40.6%, <jats:italic>n<\/jats:italic>\u2009=\u200956) were the most recommended modes of intubation. Three patients with airway emergencies had previously documented airway management plans and were successfully intubated without complications following the primary intubation technique recommended in their consult note.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In our study, nurse\u2010screening identified patients at high\u2010risk for a difficult airway that would likely not have been identified prior to initiation of a screening protocol. Furthermore, airway management plans outlined prior to an emergent difficult airway event may increase first\u2010attempt success at securing the difficult airway, reducing morbidity and mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.14488","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T12:24:41Z","timestamp":1721823881000},"page":"1207-1214","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Preemptive airway management planning: A retrospective evaluation of the pediatric difficult airway consultation service"],"prefix":"10.1111","volume":"68","author":[{"given":"Nicholas M.","family":"Dalesio","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology\/CCM Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Otolaryngology\/Head &amp; Neck Surgery, Division of Pediatric OHNS Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3263-983X","authenticated-orcid":false,"given":"Mohammed N.","family":"Ullah","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laeben","family":"Lester","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology\/CCM Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munfarid","family":"Zaidi","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Chu","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aileen","family":"Mendez","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology\/CCM Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vania","family":"Milnes","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology\/CCM Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaitlyn","family":"Vaughn","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology\/CCM Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology\/CCM Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Tunkel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\/Head &amp; Neck Surgery, Division of Pediatric OHNS Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sapna R.","family":"Kudchadkar","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology\/CCM Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\/Head &amp; Neck Surgery, Division of Pediatric OHNS Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,7,24]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e31827773b2"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460\u20109592.2012.03813.x"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12144"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010014\u20103407\u20104"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild\u20102018\u2010316336"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.16118"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2018\u20100226"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12625"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13783"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(20)32532\u20100"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000004002"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213\u20102600(15)00508\u20101"}],"container-title":["Acta Anaesthesiologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aas.14488","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T01:55:28Z","timestamp":1743904528000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aas.14488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,24]]},"references-count":12,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1111\/aas.14488"],"URL":"https:\/\/doi.org\/10.1111\/aas.14488","archive":["Portico"],"relation":{},"ISSN":["0001-5172","1399-6576"],"issn-type":[{"type":"print","value":"0001-5172"},{"type":"electronic","value":"1399-6576"}],"subject":[],"published":{"date-parts":[[2024,7,24]]},"assertion":[{"value":"2024-01-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}