An endotracheal tube inserted to the level of the hypopharynx is an easy, safe, and effective technique for ventilation of pediatric patients: A prospective observational study.

BACKGROUND: Difficult intubation and facemask ventilation in infants and small children can lead to rapid oxygen desaturation. An endotracheal tube (ETT) with its tip positioned in the hypopharynx is readily available and bypasses the soft palate, tongue, and epiglottis of the child, thus saving time by providing safe and efficient hypopharyngeal ventilation to ensure proper oxygenation. METHODS: This prospective, observational study included 85 infants and children aged >1 month and ≤ 6 years old, undergoing elective surgery under general anesthesia with orotracheal intubation. The effectiveness and safety of hypopharyngeal ETT ventilation performed by clinical anesthesia (CA) residents was evaluated. The primary objective of this study was to assess the efficacy of this technique in providing successful ventilation evidenced by visible chest rise, the presence of a sustained end-tidal capnography (EtCO2) waveform, stable oxygen saturation (SpO2) values, and an adequate expired tidal volume. Secondary outcomes included the incidence of severe hypoxemia (SpO2 < 85%), bradycardia, stomach insufflation, and laryngospasm. RESULTS: Successful ventilation by CA residents was achieved in 82 patients (96.5%) evidenced by visible chest rise, at least eight EtCO2 waveforms, stable SpO2 values, and adequate expired tidal volume. When stratified by CA resident groups, successful ventilation rates did not differ significantly (p = 0.407). Stomach insufflation occurred in 3 patients (3.5%) while severe hypoxemia (SpO₂ < 85%), bradycardia, and laryngospasm were not observed. CONCLUSIONS: Hypopharyngeal ETT ventilation performed by CA residents is an effective and safe technique of ventilation in infants and children ≤6 years old with normal airways. Its role as an alternative for facemasks or supraglottic airway devices in pediatric airway management may be subject for future trials. CLINICAL TRIAL NUMBER: NCT06449924. CLINICALTRIALS: com registry URL:https://clinicaltrials.gov/study/NCT06449924.