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Difficult to Ventilate and Oxygenate: The Pediatric Airway Overview

Besides anatomic differences, there are physiologic differences that impact the management of the pediatric airway. Pediatric patients have a higher oxygen demand and oxygen consumption. Combined with smaller airway volumes, the higher oxygen demand and consumption results in lower functional residual capacity and a smaller oxygen reserve. Additionally, abdominal distension, most commonly due to too much BVM ventilation prior to intubation, can lead to decreased functional residual capacity and O2 desaturation... Management of the airway should always include preparation for possible difficulties. Familiarizing yourself with the location of the necessary equipment and a step-wise assessment…

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Articles of Interest

The pediatric can’t intubate can’t oxygenate scenario (Use a knife)

In children under the age of 8, the cricoid membrane may be too small for a cricothyroidotomy. There is a lot of variability, and no one should use 8 as a strict binary cut-off. Cricothyroidotomy may still be a reasonable approach, but in younger children a surgical tracheostomy should be the first choice for emergency front of neck access in a can’t intubate can’t oxygenate scenario.

Advances in Emergent Airway Management in Pediatrics

Airway management is the cornerstone to resuscitation efforts for many critically ill pediatric patients presenting for emergency care. Pediatric endotracheal intubation is uncommon in emergency medicine, making it challenging to maintain comfort with this critical procedure.

Emergency airway management in children: Unique pediatric considerations

Although the indications for airway management in children are similar to those in adults, unique pediatric anatomy and physiology create specific challenges in assessment and management...

Management of Paediatric Airway Emergencies: A Systematic Review of Current Practice Guidelines and Clinical Outcomes

Paediatric airway emergencies can be life-threatening and require prompt and effective management to ensure optimal outcomes. The incidence of paediatric airway emergencies has been reported to be as high as 5.4% in the pre-hospital setting. These emergencies can be caused by a variety of factors including trauma, infection, foreign body aspiration, and congenital anomalies.

Pediatric Airway Management in the Emergency Department

Anatomic differences in the pediatric airway are more pronounced in younger children, especially under 1 year, and have important implications for airway management.

Pediatric difficult airway management: current devices and techniques

Adult difficult airway management techniques, such as awake or invasive approaches to airway management, often cannot be applied to children because of inadequate cooperation. Consequently, awake intubation in pediatrics is uncommon; most intubations are performed under general anesthesia or deep sedation. From a physiologic perspective, children have higher rates of oxygen consumption, significantly shortening the period of apnea that can be safely tolerated.

The difficult pediatric airway for emergency medicine

Children infrequently require advanced airway management and difficulties do not often occur. Many of the difficult airway predictors, particularly anatomic abnormalities, are more common in adults. As a result, evidence specific for children regarding identification and management of difficult airways is limited. Nevertheless, a reasonable, systematic approach for children can be developed from experience with adult patients in the ED and children in the OR.

The Pediatric Airway

An emergent pediatric airway can be a stressful event, so having a systematic approach to appropriate patient positioning and the primary equipment can increase the likelihood of success. Weight-based or length-based estimating tools are useful to identify correct doses and equipment size. Finally, being familiar with adjunct equipment can often be used to successfully manage difficult pediatric airways.

The Pediatric Airway and Rapid Sequence Intubation

Currently, pediatric airway emergencies that require a secure and advanced airway range from 0.6 to 3.3 per 1,000 cases. The median age often varies by institution; however, the highest risk patients commonly are younger than 12 months old.

The Pediatric Airway: Pearls and Pitfalls

Airway management is one of the most important skills in the evaluation of a child in distress. In a critically ill child, the evaluation begins with establishing a patent airway. Children are not small adults, and there are many anatomical and physiological differences, as well as a myriad of etiologies precipitating the event that may necessitate immediate airway management.

Resources

10 Common Pediatric Airway Problems—And Their Solutions

There is good reason why most providers are anxious about taking care of children, especially infants and children less than 2 years of age. It is challenging and intimidating to open the airway of such a small infant when adult-sized fingers dwarf the size of the baby’s mouth and all of the instruments are smaller.