PICU and Airway Management - Pediatric Critical Care - Lecture Slides, Slides of Pediatrics

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Introduction to the PICU and Airway

Management

The Purpose of Intensive Care

• Units exist to monitor patients for acute deterioration
• Units are staffed by personnel trained to react to deterioration with advanced skills
• Success in management favors the prepared mind

Airway Management

• The ability to recognize impending respiratory failure and stabilize an airway is one of the cornerstones of ICU management
• Knowledge of the pediatric airway and proficiency in its stabilization and intubation is essential

Laryngeal Cartilages

Laryngeal Anatomy

• Sensory innervation occurs from the internal branch of the superior and recurrent laryngeal nerve, motor innervation is from the recurrent laryngeal nerve
• Blood supply is provided by the superior and inferior thyroid arteries

Four Differences between the

Adult and Pediatric Airway

• Infant tongue is proportionally large
• The infants larynx is higher (rostral) in the neck (C3-4) than an adults (C4-5)
• The infants epiglottis is omega shaped (Ω) and angled away from the trachea
• The narrowest part of the larynx is the cricoid cartilage below the vocal cords

Airway Diameter and Resistance

Obstructed Inspiration/Expiration

Stridor Wheezing

Work of Breathing

• WOB per kilogram body weigh is similar in adults and children. Higher respiratory rates are due to greater O (^2) consumption - (4-6 ml/kg/min) infants, (2-3 ml/kg/min) adults
• Infant have diaphragm and intercostal muscles with fewer Type 1 (slow-twitch) fibers so they are more prone to fatigue

Airway Management

• The Goal of Airway management is to anticipate and recognize respiratory problems and to support or replace those that are compromised or lost

Pediatric Advance Life Support Manual

Airway Control

• There are many simple, non-invasive techniques to support respiration prior to undertaking endotracheal intubation - Application of oxygen - Suctioning - Positioning of the airway - Application of positive pressure - Assistance of ventilation with a BVM

Application of Oxygen

• Nasal canula (23-25%)
• Simple face mask (35-60%)
• Non-rebreather mask (80-100%)
  • High flow (10-12 l/min)
  • Reservoir of oxygen
  • Tight-fitting to face
  • Valves to prevent entrainment of room air

POSITIONING

• Use of the chin lift and jaw thrust can help restore flow through an obstructed upper airway by separating the tongue from posterior pharyngeal structures.
• The goal is to line up three divergent axes: oral, pharyngeal and tracheal.

Aligning the Axes (Initial)