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Difficult airway consultation service for children: steps to implement and preliminary results
Sydney M Nykiel-Bailey1, John D McAllister, Charles R Schrock
1Anesthesiology, Pediatric Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
Insights
A new Difficult Airway Service (DAS) was established to improve pediatric airway management. This service identifies and manages pediatric patients with difficult airways (DAW), enhancing safety and awareness across the hospital.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Emergency Medicine
Background:
- Failed airway management is a leading cause of cardiopulmonary arrest in children.
- Unlike adults, pediatric difficult airway (DAW) management lacks established consensus guidelines.
- Adverse events in pediatric DAW often occur outside the operating room, leading to poorer outcomes.
Purpose of the Study:
- To establish a Difficult Airway Service (DAS) to address the lack of guidelines for pediatric DAW.
- To outline the steps for establishing the DAS and report initial experiences.
- To improve the identification, communication, and management of pediatric patients with DAW.
Main Methods:
- The DAS mission is to identify, communicate, and manage pediatric patients with known or anticipated DAWs.
- Collaboration with referring medical and surgical services is key.
- Management occurs in settings requiring airway intervention within the patient's ongoing care.
Main Results:
- The DAS identified and managed pediatric patients with DAW during its initial 3-month operation.
- Congenital or acquired abnormalities were the primary drivers of pediatric DAW events.
- Successful implementation involved hospital-wide participation, including preoperative tracheostomy planning, EXIT procedures, airway cart standardization, and education.
Conclusions:
- The DAS provides a comprehensive approach to pediatric DAW care throughout the hospital stay and follow-up.
- The service is believed to have enhanced healthcare professional awareness and improved the safe management of pediatric airways.
- Further research is required to ascertain long-term impacts on pediatric morbidity and mortality.
Background:
Failed airway management remains one of the most common causes of cardiopulmonary arrest in the pediatric population. Practice guidelines addressing the difficult airway (DAW) in adults provide anesthesiologists a framework for managing the airway during the perioperative period; however, similar consensus guidelines are lacking in the pediatric population. Many of the adverse events associated with difficult pediatric airway management occur outside the perioperative setting and often result in worse outcomes. The lower frequency of DAW management required in children, lesser awareness of pediatric health care professionals about DAW management, and the need for guiding principles led us to develop a DAW consultative service. This report outlines the steps to establish the Difficult Airway Service (DAS) and the initial experiences with this new consultation service.
Methods:
The mission of the DAS is to identify children with known or anticipated DAWs, communicate the diagnosis and collaborate with referring medical and surgical services, and to manage children in those settings that airway management might be required in the context of the patient's ongoing medical care.
Results:
The initial 3-month experience confirmed that a majority of pediatric DAW events are associated with congenital or acquired abnormalities. Through appropriate consultation and leadership, the DAS was able to physically and electronically identify pediatric patients with a DAW and provide management. Hospital-wide participation was instrumental in the success and exponential growth of DAS: planned preoperative tracheostomy in complicated posterior spinal fusion candidates, participation in EXIT procedures, standardization of airway carts, and implementation of education forums.
Conclusion:
In developing the DAS, our goal was to provide a more comprehensive approach to caring for a child with a DAW that included their entire hospital stay and follow-up care. We believe this approach has improved health care professional awareness as well as the safe management of routine and difficult pediatric airway. Additional studies are needed to determine whether measurable changes in morbidity and mortality are observed over time.
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