Open AccessPediatric Airway Management in COVID-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia’s Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society
Author(s) -
Clyde Matava,
Pete G. Kovatsis,
Jennifer K. Lee,
Pilar Castro,
Simon Denning,
Julie Yu,
Raymond Park,
Justin L. Lockman,
Britta S. von UngernSternberg,
Stefano Sabato,
Lisa Lee,
Ihab Ayad,
Sam Mireles,
David Lardner,
Simon Whyte,
Judit Szolnoki,
Narasimhan Jagannathan,
Nicole C.P. Thompson,
Mary Lyn Stein,
Nicholas M. Dalesio,
Robert S. Greenberg,
John McCloskey,
James Peyton,
Faye M. Evans,
Bishr Haydar,
Paul I. Reynolds,
Franklin Chiao,
Brad M. Taicher,
T. Wesley Templeton,
Tarun Bhalla,
Vidya Raman,
Annery GarciaMarcinkiewicz,
Jorge A. Gálvez,
Jonathan M. Tan,
Mohamed A. Rehman,
Christy J. Crockett,
Patrick Olomu,
Peter Szmuk,
Chris D. Glover,
Maria Matuszczak,
Ignacio Galvez,
Ágnes Hunyady,
David M. Polaner,
Cheryl K. Gooden,
Grace Hsu,
Harshad Gumaney,
Caroline Pérez-Pradilla,
Edgar Kiss,
Mary C. Theroux,
Jennifer Lau,
Saeedah Asaf,
Pablo Ingelmo,
Thomas Engelhardt,
Mónica Hervías,
Eric Greenwood,
Luv Javia,
Nicola Disma,
Myron Yaster,
John E. Fiadjoe
Publication year - 2020
Publication title -
anesthesia and analgesia/anesthesia and analgesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.404
H-Index - 201
eISSN - 1526-7598
pISSN - 0003-2999
DOI - 10.1213/ane.0000000000004872
Subject(s) - medicine , intubation , intensive care medicine , airway management , pandemic , tracheal intubation , airway , nebulizer , asymptomatic , health care , anesthesia , covid-19 , disease , surgery , infectious disease (medical specialty) , pathology , economics , economic growth
The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.