Part 2 : Pediatric Airway Pearls​

Causes of Airway Obstruction​

• Respiratory virus season is upon us ​
• This means an increase in calls for respiratory symptoms, including in the pediatric population​
• This #SWORBHPTips series will review some pediatric pearls based on anatomic differences in the pediatric airway and how to alter your management strategy to optimize your ventilation in this population​
• Post #1 looked at anatomical differences and optimal positioning​
• This post will examine unique factors that cause airway obstruction and how to manage them

Obstructed Nares + Obligatory Nasal Breathing = Airway Obstruction

• Neonates do all of their breathing through their noses for the first 2-6 months​
  • This allows breathing to continue while feeding​
  • However, this also means when a virus causes nasal congestion their airway becomes obstructed​
• Gentle suctioning of the nares can help relieve this obstruction

Large Tongue = Airway Obstruction​

• To obtain the most patent airway, the large pediatric tongue may need to be cleared out of the way​
  • For non-invasive ventilation, this may mean an oral or nasal airway is required​
  • For ETT insertion: Your laryngoscopy technique may need to account for this large tongue (see Part 3 of this series for tips about advanced airways!)​

How to Size OPA/NPA​

OPA can be sized by measuring from the corner of the mouth to the angle of the mandible

NPA can be sized by measuring from the tip of the nose to the tragus of the ear

Summary: Large tongue, obligate nasal breathers, and airway obstruction​

• Suctioning to clear the nose in young infants who are obligatory nasal breathers can significantly improve work of breathing​
• In order to obtain the optimal airway patency, the large pediatric tongue may need to be displaced​
  • This may mean:​
    • Oral or nasal airway insertion​
    • Altered technique for SGA or ETT insertion (see Part 3)​

No additional resources available for this #SWORBHPTip.