Pediatric difficult airway management: Principles and approach in the critical care environment

Abstract

Airway management in the child with anatomic features that preclude effective airway management using standard techniques requires an approach tailored to the individual child’s anatomy and physiology. Optimal management necessitates careful planning, effective communication, additional equipment, qualified personnel, and appropriate medications. Therefore, training of personnel, implementation of decision algorithms, and acquisition of appropriate equipment are institutional elements that are essential in facilitating the optimal care of these children. This chapter discusses the salient principles in developing an effective approach to difficult airway management in the pediatric intensive care setting. In addition, a selection of devices useful in pediatric difficult airway management is presented. Finally, institutional systems-based considerations for difficult airway management in the critically ill child are discussed. Pediatric difficult airway management in the intensive care environment presents a wide range of challenges. Children in whom airway management is expected to be difficult are often unable to cooperate with awake airway management techniques that are often the primary approach in adult patients. The availability of a variety of indirect laryngoscopes has significantly increased the intensivist’s ability to safely manage many of these children in the ICU. Successful airway management in these children requires careful planning, preparation, and often multidisciplinary cooperation.