Precision decisions in pediatric airway management: addressing physiologic difficulty

Precision medicine is based on the idea that treatment can be individualized for each patient in a given clinical environment. This review summarizes factors that should be considered when clinicians are creating individualized plans for intubation, specifically focusing on physiologically difficult airways. Recent literature identifying physiologic risk factors is summarized, and individual and system-level interventions that can potentially mitigate risk are reviewed.

Physiologic derangements, most notably hypoxia and hypotension, have been associated with increased incidence of severe adverse events during intubation attempts. Individualized peri-procedural efforts to improve physiologic parameters through optimal oxygen delivery, fluid resuscitation, vasopressor administration, and thoughtful choice in rapid sequence intubation (RSI) medications may improve patient outcomes. Systems of care are being built around airway bundles, cognitive aids, and collaborations with airway teams to optimize outcomes.

Providers should develop individualized care plans for their patients to optimize physiologic and anatomic parameters peri-intubation. The physiologically difficult airway affects the rate of first pass success and adverse events, therefore patients should be optimized prior to undergoing the procedure based on their clinical presentation and data.