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Management of the Normal and Difficult Pediatric Airway: Unique Challenges in the Time of COVID-19
Edgar Kiss1,2, Annery Garcia-Marcinkiewicz3,4, John Zhong1,2
1Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX USA.
Insights
During the COVID-19 pandemic, pediatric airway management evolved significantly. Personal protective equipment and vaccination are key for protecting healthcare workers and patients during these interventions.
Area of Science:
- Pediatric Anesthesiology
- Infectious Disease Control
- Acute Care Medicine
Background:
- The COVID-19 pandemic presented unique challenges for managing pediatric airways in acute care settings.
- Initial guidelines for protecting healthcare workers from SARS-CoV-2 evolved as understanding of the virus and effective interventions grew.
- The definition of aerosol-generating procedures was broadened, impacting clinical practice.
Purpose of the Study:
- To review the challenges in normal and difficult pediatric airway management during the COVID-19 pandemic.
- To examine the evolution of protocols and practices for pediatric airway interventions amidst the pandemic.
- To discuss the current knowledge regarding surgical and anesthesia timing in pediatric patients during the pandemic.
Main Methods:
- Review of existing literature and guidelines related to pediatric airway management during the COVID-19 pandemic.
- Analysis of the impact of SARS-CoV-2 on acute care practices.
- Evaluation of the effectiveness of various protective measures and procedural modifications.
Main Results:
- Aerosol containment devices were found to be largely ineffective and potentially harmful.
- Personal protective equipment (PPE) and COVID-19 vaccination emerged as the most effective protective measures for healthcare workers.
- Evidence-based public health measures and PPE are crucial for safe pediatric perioperative care.
Conclusions:
- Adaptability to emerging evidence is essential for clinicians managing pediatric airways during and after the COVID-19 pandemic.
- Continued emphasis on vaccination and appropriate PPE is vital for patient and healthcare worker safety.
- The management of the pediatric airway requires ongoing reassessment of protocols in light of evolving viral threats.
Purpose Of Review:
This review focuses on the challenges faced by acute care healthcare workers in the management of the normal and difficult pediatric airway during the COVID-19 pandemic and how these protocols and practices evolved during the pandemic. The current state of knowledge on timing of surgery and anesthesia is also discussed.
Recent Findings:
In the early days of the pandemic, information about the SARS-CoV-2 virus and disease process was scarce. Governmental, healthcare, and professional organizations created several guidelines to protect invaluable healthcare workers from the contagious virus while also delivering appropriate care to children with COVID-19. With the emergence of new studies and the deployment of new life-saving COVID-19 vaccines and other therapies, these guidelines evolved. The use of aerosol containment devices such as aerosol boxes and flexible barrier techniques was found to be ineffective in reliably containing virus particles while posing potential harm to both healthcare workers and patients. Also, the definition of aerosol-generating and dispersing medical procedures was vastly broadened. To date, use of appropriate personal protection equipment and COVID-19 vaccination are the most effective ways to protect healthcare workers and safely manage children infected with SARS-CoV-2 who require airway intervention.
Summary:
Evidence-based public health measures and appropriate personal protective equipment remain the best way to protect both healthcare workers and patients. As the virus and population evolve and COVID-19 vaccines become more widely available, clinicians must be willing to adapt to the emerging evidence of their impact on how safe pediatric perioperative care is delivered.
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