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Airway management in children with COVID-19
K K Y Leung1, S W Ku1, R C M Fung1
1Paediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong.
Insights
Healthcare workers face high COVID-19 risks during pediatric airway management. This study offers a simplified approach for intubation, prioritizing staff safety and infection control during critical procedures.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pediatrics
Background:
- COVID-19 poses significant risks to healthcare professionals, especially during aerosol-generating procedures like airway management.
- Pediatric patients, while often experiencing milder COVID-19, still require specialized respiratory support.
- Protecting healthcare workers and preventing viral transmission during pediatric critical care is paramount.
Purpose of the Study:
- To propose a novel airway management strategy for pediatric patients during the COVID-19 pandemic.
- To provide clear instructions for both elective and emergency intubation procedures.
- To minimize infection risk for healthcare providers during high-risk airway interventions.
Main Methods:
- Development of a simplified airway management protocol for elective and emergency pediatric intubations.
- Emphasis on appropriate personal protective equipment (PPE) and equipment for healthcare workers.
- Recommendations include avoiding bag-mask ventilation and utilizing bacterial/viral filters in the respiratory circuit.
Main Results:
- The proposed approach streamlines intubation methods to reduce complexity and exposure time.
- Incorporation of specific infection control measures, such as filter use and PPE, is highlighted.
- The strategy aims to balance effective respiratory support with maximal protection for medical staff.
Conclusions:
- A simplified, safety-focused airway management approach is crucial for pediatric critical care during viral pandemics.
- This framework enhances infection prevention during high-risk procedures for novel viral illnesses.
- The protocol supports pediatric critical care practitioners in managing respiratory failure while safeguarding staff.
Abstract:
The novel coronavirus disease (COVID-19) may result in acute respiratory distress syndrome and respiratory failure, necessitating mechanical respiratory support. Healthcare professionals are exposed to a particularly high risk of contracting the virus while providing resuscitation and respiratory support, which may in turn result in grave consequences and even death. Although COVID-19 has been shown to cause milder disease in children, paediatricians and intensivists who provide care for children must be prepared to provide optimal respiratory support without putting themselves or other medical, nursing, and paramedical staff at undue risk. We propose an airway management approach that is especially relevant in the current COVID-19 pandemic and provides instructions for: (1) Elective intubation for respiratory failure; and (2) Emergency intubation during cardiopulmonary resuscitation. To minimise risk, intubation methods must be kept as straightforward as possible and should include the provision of appropriate personal protection and equipment to healthcare workers. We identify two key considerations: that bag-mask ventilation should be avoided if possible and that bacterial and viral filters should be placed in the respiratory circuit. Our novel approach provides a framework for airway management that could benefit paediatric critical care practitioners who provide care for any children with a novel viral illness, with a focus on infection prevention during high-risk airway management procedures.
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