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Emergency pediatric tracheostomy: a usable technique and model for instruction
Insights
A new technique for emergency pediatric tracheostomy uses a finder needle and saline syringe to locate the trachea in small subjects. This feline model allows emergency physicians to practice rapid tracheostomies on pediatric-sized airways.
Area of Science:
- Emergency Medicine
- Pediatric Airway Management
- Surgical Simulation
Background:
- Emergency pediatric tracheostomy is rarely performed but critical when cricothyrotomy is not feasible.
- Indications include small cricothyroid space, high-grade airway obstruction, or obscured landmarks due to swelling or fractures.
- A reliable training model is needed for emergency physicians to practice this procedure on pediatric-sized airways.
Purpose of the Study:
- To develop and evaluate a novel technique for emergency pediatric tracheostomy.
- To establish a practical animal model for practicing this procedure on pediatric-sized tracheas.
Main Methods:
- A new technique utilizing a finder needle and saline-filled syringe to locate the trachea in small subjects.
- A feline model was employed, with kittens (1000-1500g) approximating infants and larger cats (2000-3000g) approximating older children.
- The technique involves needle insertion, saline aspiration to confirm tracheal entry, a stabbing incision, stoma dilation, and endotracheal tube insertion.
Main Results:
- The finder needle and saline syringe technique successfully identified the trachea in the feline model.
- The feline model provided anatomically relevant tracheal sizes for pediatric patients.
- The procedure was demonstrated to be feasible for practicing rapid tracheostomies on small subjects.
Conclusions:
- A novel technique and feline model for emergency pediatric tracheostomy training have been developed.
- This model allows emergency physicians to gain proficiency in performing tracheostomies on pediatric-sized airways.
- Further studies are needed to evaluate this technique in human pediatric patients.
Abstract:
Tracheostomies, although rarely performed, may be necessary in cases in which a cricothyrotomy is precluded by the small size of the cricothyroid space in infants and small children, when there is a high-grade upper airway obstruction, or when massive neck swelling or laryngeal fractures obscure the cricothyroid landmarks. A new technique for emergency pediatric tracheostomy and a model for practicing the procedure in cats has been developed. The technique uses a finder needle and a saline-filled syringe to locate the small and poorly defined trachea. Free-flowing saline or aspirated air bubbles indicate entrance of the locator needle into the tracheal lumen. A stabbing incision is made lateral to and against the needle, the stoma is spread, and an endotracheal tube is introduced. Kittens weighing 1,000 g to 1,500 g have a tracheal diameter of 5.5 mm to 6.0 mm, equivalent to a child less than 1 year old. Cats in the 2,000-g to 3,000-g range approximate the tracheal size for an older child. Either recently killed or anesthetized cats may be used. Using this model, emergency physicians can become more proficient in performing tracheostomies rapidly on small subjects. This technique, however, has not been studied in human beings of the pediatric age group.