Pediatric Airway Management

A young child with a respiratory issue who is rushed to the local emergency department with sudden cardiac arrest may require intubation. Another child might go into anaphylaxis following exposure to an unknown trigger, also requiring intubation. In these extreme situations, medical personnel need to act swiftly and confidently. With the proper training and access to the latest technology, hospital EDs can be prepared to care for the airways of the littlest patients.

“Early interventions help to improve morbidity, and patients generally have a shorter length of stay in the hospital,” stated Alicia Jones, RRT, NPS, BSRT, director of respiratory services, University Medical Center of Southern Nevada and Children’s Hospital of Nevada in Las Vegas. “The fewest possible days on a ventilator is best for the patient; resulting in less harm to the lungs and less chance of a ventilator-associated event, according to Jones. “When lung protective strategies or specialized ventilation is used as an early intervention, it provides additional lung protection,” she said.

Infant & Pediatric Intubation
At Children’s Hospital of Nevada, all practitioners, including pediatric intensivists, anesthesiologists and respiratory care practitioners are highly trained and skilled in intubation of the infant and pediatric patient.

“We’re consistently staffed with the right practitioners to handle any pediatric airway issue, and have a large variety of airways and devices to handle both the normal or difficult intubations,” Jones said.

When a child is sick, parents understandably prefer to be at a pediatric hospital, but with a situation requiring immediate action, that is not always possible. Community hospitals can be prepared to optimize patient outcomes as well. Northwest Hospital in in Randallstown, Md., relies on equipment and training to level the playing field, explained Tanveer Gaibi, MD, chief of the hospital’s department of medicine.

Pediatric Airway Management“We’re fortunate because pediatric airway issues are rare in our hospital, but we want to have the best options available and a seamless plan of care in place for when they occur,” Gaibi shared.

Northwest Hospital recently received a pediatric GlideScope through a donation by Baltimore’s JHB Hope Foundation. The hospital regularly uses an adult GlideScope but the pediatric version is designed specifically for a child’s small airway

“Infant and pediatric patient airways tend to be anterior, which creates a difficult line of vision from the mouth to the larynx,” Jones explained. “This can be challenging for a practitioner not skilled in this type of airway. There must always be the correct size of airways available and the right equipment to accommodate all of the different sizes and airways that are needed.”

The GlideScope fits into the obstructed airway of a small child so a breathing tube can be placed in the throat to keep the airway open. It uses video technology so doctors can see a real-time, distinct view of where to place the tube safely, accurately and quickly. “The device ensures direct visualization of vocal cords to confirm that we are intubating correctly,” said Gaibi.

SEE ALSO: Home Care Ventilation for Children

Airway Intervention Training & Education
Children’s Hospital of Nevada stocks carts with the equipment needed to handle any emergency or difficult airway situation. According to Jones, the carts are equipped with: laryngoscope handles and blades (both Miller sizes 0-3 and MacIntosh sizes 1-3); endotracheal tubes both cuffed and uncuffed from size 2.0 to 8.0; GlideScope; cricothyrotomy kit; laryngeal mask airways; colorimetric end-tidal CO2 detector (pediatric and adult); stylettes and a bougie airway device.

“Our staff is adequately trained and familiar with intubation and difficult airway management,” Jones relayed. “They are able to recognize respiratory decomposition in their patients and are familiar with the indications and techniques for airway intervention, such as assuring the patient has a patent airway, and providing proper oxygenation and ventilation.”

At Children’s Hospital of Nevada, the interventions may include using a GlideScope or bougie airway device for difficult intubations, or a jaw thrust to help maintain the airway. “Difficult airways are always identified and marked on the endotracheal tube, for easy identification and patient safety,” Jones stated.

The GlideScope, and similar technology, can expedite immediate lifesaving pediatric interventions. Once a patient has been stabilized at Northwest Hospital, the ED staff ensures the patient’s safe transfer to a higher level of care. “Once we establish a definitive airway, we send the patients to Sinai Hospital, a sister organization within our system that has a pediatric ICU,” Gaibi shared.

Gaibi feels fortunate to have the equipment and resources needed to provide patients with the most optimal care. “When you’re a community hospital that doesn’t have a pediatric ICU, it’s nice to have a good, working relationship with one that does,” he observed. “Our partnership helps the children have the best outcomes. We follow up about what went well with each patient, which can be helpful in caring for future patients.”

Gaibi and his team insist on keeping up with the latest literature, but the staff at Sinai Hospital also shares protocols to streamline the continuum of care and continually educate the staff on the best ways to approach emergencies.

“Families want the best for their children,” Gaibi stated. “We’re able to reassure them that we’ve given our patients every opportunity they could have, and our technology and training helps us do that.”

Rebecca Mayer Knutsen is on staff. Contact: [email protected]

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