Intubating a Child With a Difficult Airway: The Otolaryngologist Perspective

Tuesday, October 3, 2023

9:15 AM - 9:21 AM East Coast USA Time

Location: 207CD

Presenting Author(s)

Ashley E. Young, BS

Medical Student
Northwestern University
Lincolnshire, Illinois, United States

Co-Author(s)

IH

Inbal Hazkani, MD

Fellow
Lurie Childrens Hospital/ Northwestern University
Chicago, IL, United States

Co-Author(s)

Matthew J. Rowland, MD

Assistant Professor
Lurie Children's Hospital/ Northwestern University
Chicago, IL, United States
MS

Maeve A. Serino, MD

Resident
Temple University Hospital
Chicago, IL, United States
NJ

Narasimhan Jagannathan, MD

Arizona University, Phoenix Children's Hospital, USA
Saied Ghadersohi, MD

Assistant Professor
Lurie Children's Hospital, Northwestern University
Chicago, IL, United States
Taher S. Valika, MD

Assistant Professor
Lurie Children's Hospital, Northwestern University
Chicago, IL, United States

Senior Author(s)

Jonathan B. Ida, MD

Associate Professor, Otolaryngology - Head & Neck Surgery
Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine
Chicago, Illinois, United States

Disclosure(s):

Ashley E. Young, BS: No relevant relationships to disclose.

Introduction: 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 Rapid Difficult Airway Response team (RaDAR) in an academic tertiary-care children’s hospital between 12/2019-12/2021. 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, 29 (37.2%) were intubated by an otolaryngologist. Of these, 20 (69.0%) were recognized and signaled as a “difficult airway” prior to 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 22/26 patients; the remaining patients were intubated by otolaryngology attending. None of the patients required front-of-neck airway intervention.

Conclusions: Otolaryngologists have unique skills and instruments that may assist with the management of a child with a difficult airway. Proactive recognition and signaling of patients at risk for difficult airway are key factors for safe airway securement.