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Bedside intubation of a child with a difficult airway-The otolaryngologist perspective
Inbal Hazkani1,2, Matthew J Rowland3,4, Maeve A Serino1,4
1Division of Pediatric Otolaryngology-Head and Neck Surgery Ann and Robert H. Lurie Children's Hospital of Chicago Chicago USA.
Insights
Otolaryngologists successfully managed difficult pediatric airways using advanced techniques when traditional methods failed. Early recognition and specialized skills are crucial for safe pediatric airway management.
Area of Science:
- Pediatric Otolaryngology
- Airway Management
- Emergency Medicine
Background:
- Difficult pediatric airways pose significant risks for severe complications during intubation.
- Otolaryngologists are frequently involved in managing complex pediatric airways using advanced techniques.
Purpose of the Study:
- To describe the experience of otolaryngologists in managing bedside difficult pediatric airway events.
- To highlight the role of otolaryngologists in securing airways when conventional methods fail.
Main Methods:
- A case series with chart review was conducted.
- Data from children intubated by the difficult airway response (RaDAR) team between January 2020 and December 2021 were analyzed.
- Methods for recognizing and signaling difficult airways were described.
Main Results:
- Otolaryngologists managed 28 of 78 (37.2%) airway code events.
- In 71.4% of cases, the difficult airway was recognized and signaled prior to intubation.
- Advanced techniques including flexible and rigid bronchoscopy were utilized, with an average of 1.93 attempts to secure the airway. No bedside tracheostomies were required.
Conclusions:
- Otolaryngologists possess unique skills and instruments beneficial for managing difficult pediatric airways.
- Effective management relies on collaboration with anesthesia, proper training, and proactive identification of at-risk patients.
Objectives:
Children with a difficult airway are prone to severe complications in unplanned intubation events. The otolaryngologist is often required to secure the airway using advanced techniques once the traditional methods have failed to establish safe tracheal intubation. The goal of our study was to describe the otolaryngologist's experience in the management of bedside difficult pediatric airway events.
Methods:
A case series with chart review of children intubated by the difficult airway response (RaDAR) team in an academic tertiary-care children's hospital. The electronic medical charts of patients intubated by the RaDAR team between Jan 2020 and Dec 2021 were reviewed. The steps taken to recognize and signal patients with a difficult airway are described.
Results:
Of the 78 airway code events managed by the RaDAR team, 28 (37.2%) were intubated by an otolaryngologist. Of these, 20 (71.4%) were recognized and signaled as a "difficult airway" before emergent intubation. The methods to secure the airway were direct laryngoscopy (n = 7), flexible bronchoscopy with/without a laryngeal mask (n = 10), rigid bronchoscopy (n = 8), and video laryngoscopy (n = 1). On average, there were 1.93 attempts to secure the airway following RaDAR activation. The airway was secured by an otolaryngology trainee in 24/28 patients. None of the patients required bedside tracheostomy.
Conclusions:
Otolaryngologists have unique skills and instruments that may assist with the management of a child with a difficult airway. Close collaboration with anesthesia colleagues, proper training, and proactive recognition and signaling of patients at risk for difficult airway are key factors for safe airway securement.
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