Airway Management: An overview

Shamili Jenifer

Staff Nurse, Maa Kauvery, Trichy, Tamil Nadu

Introduction

Pediatric Airway Management

The airway of the pediatric patient differs in many ways, which impact the management of the airway.

Objectives

  • Recognize the signs and symptoms of unstable airway
  • Recognize the signs and symptoms of respiratory failure
  • Describe how to maintain airway
  • Explain how to support a baby with bag and mask ventilation
  • Provide adequate ventilation and improve oxygenation

Assessment of Respiration

Abnormal Respiratory Rate and PatternIncreased Respiratory EffortInadequate Respiratory Effort
Irregular respiratory patternNasal FlaringApnea
TachypnoeaRetractionsWeak Cry
BradypnoeaHead BobbingBradypnea
ApnoeaAgonal Gasp

Abnormal Respiratory Rate and Pattern

Irregular Respiratory Pattern

  • A deep gasping breath followed by a period of apnea
  • A rapid respiratory rate followed by a period of apnea
  • These patterns are serious and require urgent evaluation

Fast Respiratory Rate

  • High Fever
  • Pain
  • Anemia
  • Cyanotic Congenital heart disease
  • Metabolic acidosis
  • Dehydration
  • Sepsis

Slow Respiratory Rate

  • Respiratory Muscle Fatigue
  • CNS Injury
  • Severe Shock
  • Severe Hypoxia
  • Hypothermia

Apnea

  • Apnea is when breathing stops more than 20 sec

Increased Respiratory Effort

Nasal Flaring

  • Nasal flaring is dilation of the nostrils with each inhalation

Retraction

  • Mild to Moderate – Subcostal / Sub sternal / Intercostal
  • Severe – Supra Clavicular / Supra Sternal / Sternal

Head Bobbing or Seesaw Respiration

Head bobbing is caused by using neck muscle to assist breathing.

Inadequate Respiratory Effort

  • Apnea
  • Weak Cry
  • Bradypnea
  • Agonal Gasp

Management of Airway-Simple Measures

  • Positioning – Head Tilt, Chin Lift/Jaw Thrust/Up right/ Lateral
  • Suctioning – Nose / Oro pharynx
  • Relief Techniques for foreign body airway obstruction

Oxygen delivery System

  • Simple Oxygen Mask
  • Nasal Prongs
  • Non Re-breathing Mask
  • Venturi Mask
  • Oxygen Tent
  • Oro Pharyngeal Airway
  • Naso Pharyngeal Airway (Hood)
  • Laryngeal Mask Airway
  • I gel
  • HFNC
  • Advanced Airway Management – ETT

Size Measurement

  • Nasal Prongs – Neo-natal/Pediatric/Adult
  • Oxygen Mask –The mask should extend from the bridge of the nose to the cleft of the chin

Naso-Pharyngeal

Fig (1): From the tip of the nose to the tragus of the ear

Oro-Pharyngeal

AMBU-EC clamp

Laryngeal Mask Airway

I Gel

  • Size 3 for weight < 50 kg,
  • Size 4 for weight 50–90 kg
  • Size 5 for weight > 90 kg.

Advanced Airway management

ETT Intubation

Size Calculation

  • Un cuffed ETT: Size = (age/4) + 4
  • Cuffed ETT: Size = (age/4) + 3

Always keep one size above and one size below the measured value

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