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Pediatric Microlaryngoscopy and Bronchoscopy in the COVID-19 Era
Katherine Pollaers1, Hayley Herbert1, Shyan Vijayasekaran1,2
1Perth Children's Hospital, Nedlands, Western Australia, Australia.
Importance:
As an aerosol-generating procedure, traditional pediatric microlaryngoscopy and bronchoscopy techniques must be adapted in order to reduce the risk of transmission of severe acute respiratory syndrome coronavirus 2.
Objective:
To describe a modified technique for pediatric microlaryngoscopy and bronchoscopy for use in the COVID-19 era and present a case series of patients for whom the technique has been used.
Design, Setting, And Participants:
Observational case series of pediatric patients undergoing emergency or urgent airway procedures performed at a tertiary pediatric otolaryngology department in Australia. Procedures were completed between March 23 and April 9, 2020, with a median (range) follow-up of 24.5 (11-28) days.
Exposures:
Modified technique for microlaryngoscopy and bronchoscopy, minimizing aerosolization of respiratory tract secretions.
Main Outcomes And Measures:
The main outcome was the feasibility of technique, which was measured by ability to perform microlaryngoscopy and bronchoscopy with comparable success to the usual technique (ie, adequate examination of the patient for diagnostic procedures and ability to perform interventional procedures).
Results:
The technique was used successfully in 8 patients (median [range] age, 160 days [27 days to 2 years 6 months]); 5 patients were male, and 3 were female. Intervention was performed on 6 patients; 2 balloon dilations for subglottic stenosis, 2 injections of hyaluronic acid for type 1 clefts, and 2 cold-steel supraglottoplasties. No adverse events occurred.
Conclusions And Relevance:
In this case series, feasibility of a modified technique for pediatric microlaryngoscopy and bronchoscopy was demonstrated. By reconsidering the surgical approach in light of specific COVID-19 infection risks, this technique may be associated with reduced spread of aerosolized respiratory secretions perioperatively and intraoperatively, but the technique and patient outcomes require further study.
Insights
This study presents a modified pediatric microlaryngoscopy and bronchoscopy technique to reduce severe acute respiratory syndrome coronavirus 2 transmission. The technique was successfully used in 8 pediatric patients, demonstrating feasibility for airway procedures during the COVID-19 pandemic.
Area of Science:
- Pediatric Otolaryngology
- Minimally Invasive Airway Surgery
- Infectious Disease Control in Healthcare
Background:
- Traditional pediatric microlaryngoscopy and bronchoscopy are aerosol-generating procedures.
- Adapting these techniques is crucial to minimize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission.
- The COVID-19 pandemic necessitates modifications for safe pediatric airway interventions.
Purpose of the Study:
- To describe a modified technique for pediatric microlaryngoscopy and bronchoscopy.
- To present a case series of pediatric patients undergoing these modified procedures.
- To evaluate the feasibility and safety of the adapted technique in the COVID-19 era.
Main Methods:
- An observational case series of 8 pediatric patients undergoing urgent airway procedures.
- A modified microlaryngoscopy and bronchoscopy technique was employed to minimize aerosolization.
- Procedures were performed at a tertiary pediatric otolaryngology department between March and April 2020.
Main Results:
- The modified technique was successfully applied in all 8 pediatric patients.
- Interventions included balloon dilations, hyaluronic acid injections, and supraglottoplasties.
- No adverse events were reported during or after the procedures.
Conclusions:
- A modified pediatric microlaryngoscopy and bronchoscopy technique is feasible and potentially reduces aerosolized respiratory secretions.
- This adapted approach may enhance safety during the COVID-19 pandemic.
- Further research is needed to validate patient outcomes and long-term efficacy.
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