Pediatric airway management guidelines for COVID-19 patients relies upon non-clinical studies, infectious disease data and expert opinion.

pearl

• Clyde T Matava, Pete G Kovatsis, Jennifer K Lee, Pilar Castro, Simon Denning, Julie Yu, Raymond Park, Justin L Lockman, Britta Von Ungern-Sternberg, Stefano Sabato, Lisa K Lee, Ihab Ayad, Sam Mireles, David Lardner, Simon Whyte, Judit Szolnoki, Narasimhan Jagannathan, Nicole Thompson, Mary Lyn Stein, Nicholas Dalesio, Robert Greenberg, John McCloskey, James Peyton, Faye Evans, Bishr Haydar, Paul Reynolds, Franklin Chiao, Brad Taicher, Thomas Templeton, Tarun Bhalla, Vidya T Raman, Annery Garcia-Marcinkiewicz, Jorge Gálvez, Jonathan Tan, Mohamed Rehman, Christy Crockett, Patrick Olomu, Peter Szmuk, Chris Glover, Maria Matuszczak, Ignacio Galvez, Agnes Hunyady, David Polaner, Cheryl Gooden, Grace Hsu, Harshad Gumaney, Caroline Pérez-Pradilla, Edgar E 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, and PeDI-Collaborative.
• From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada.
• Anesth. Analg. 2020 Jul 1; 131 (1): 617361-73.

AbstractThe 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.

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