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Children
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Pediatric Airway Management: Advances and Future Challenges
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Pediatric Airway Management: Advances and Future Challenges

A special issue of Children (ISSN 2227-9067).

Deadline for manuscript submissions: closed (15 April 2024) | Viewed by 8955

Special Issue Editor

Dr. Hiroshi Hoshijima

E-Mail Website
Guest Editor
Div Dentooral Anesthesiol, Grad Sch Dent, Tohoku Univ, Aoba Ku, Seiryomachi 4-1, Sendai, Miyagi 9808575, Japan
Interests: anesthesia; intubation; airway management; anesthesiology; ICU; pain management; CPR; general anesthesia

Special Issue Information

Dear Colleagues,

Children are said to be difficult to intubate because they are anatomically smaller than adults. Additionally, because their lungs have not yet grown sufficiently, children are prone to hypoxia. Therefore, mask ventilation, tracheal intubation, and supraglottic device insertion should be carried out quickly and carefully.

In this Special Issue, we analyze whether new intubation devices (e.g., indirect laryngoscope) and new supraglottic devices (e.g., LMA type) can be used effectively and safely for mask ventilation, tracheal intubation, and insertion of supraglottic devices for children. In addition, we will discuss new methods for securing airways.

Recently, a meta-analysis was published showing that indirect laryngoscopes favor tracheal intubation in children. A meta-analysis comparing the degree of adhesion to the nasopharynx for LMA in children has also been published.

We aim to further deepen research on securing the upper airway in children and to enable safer anesthesia management and ICU management.

Dr. Hiroshi Hoshijima
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (4 papers)

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8 pages, 1315 KiB  
Article
Plain Radiographic Analysis of Laryngeal Dimensions in Young Children: Normal versus Croup
by Youngdae Kim, Ji-Eun Park and Jung-Heon Kim
Children 2022, 9(10), 1532; https://0-doi-org.brum.beds.ac.uk/10.3390/children9101532 - 07 Oct 2022
Cited by 1 | Viewed by 2920
Abstract
(1) Background: Contrary to a tenet of the funnel-shaped pediatric larynx with the cricoid level being narrowest, recent studies show the glottis and subglottis as the narrowest levels. To locate the functionally narrowest level of the larynx, we reported normal laryngeal dimensions and [...] Read more.
(1) Background: Contrary to a tenet of the funnel-shaped pediatric larynx with the cricoid level being narrowest, recent studies show the glottis and subglottis as the narrowest levels. To locate the functionally narrowest level of the larynx, we reported normal laryngeal dimensions and their croup-related changes in young children. (2) Methods: We reviewed normal plain neck radiographs recorded for the evaluation of minor trauma or foreign bodies in 504 children aged ≤4 years who visited the emergency department from 2016 through 2021. Using computed tomography-based localization of the glottis, we radiographically defined the subglottis and cricoid. At these levels, we measured diameters and calculated cross-sectional areas (CSAs) on the radiographs. The values were compared to the equivalent values of a 1:1 age-matched population with croup. (3) Results: In the study population (n = 401), the narrowest diameter and CSA were observed in the glottis. In detail, the mean anteroposterior/transverse diameters were 9.8/3.4 mm at the glottis, 8.5/5.6 mm at the subglottis, and 7.4/6.8 mm at the cricoid (p < 0.001), respectively. In the same order, the mean CSAs were 26.5, 38.1, and 40.5 mm2 (p < 0.001). All dimensions were narrower in the croup population (p < 0.001). We found croup-related narrowing, namely reductions in the transverse diameter and CSA that were more severe closer to the glottis (p < 0.001), without differences per level in the anteroposterior diameter. (4) Conclusions: This study confirms the glottis as the narrowest level of the larynx in young children. In addition, level-based differences in croup-related narrowing suggest some point between the glottis and subglottis as the functionally narrowest level. Full article
(This article belongs to the Special Issue Pediatric Airway Management: Advances and Future Challenges)
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14 pages, 2111 KiB  
Article
Effectiveness of Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis
by Hiroshi Hoshijima, Takahiro Mihara, Shinichi Kokubu, Sakura Takeda, Toshiya Shiga and Kentaro Mizuta
Children 2022, 9(9), 1280; https://0-doi-org.brum.beds.ac.uk/10.3390/children9091280 - 25 Aug 2022
Cited by 2 | Viewed by 1595
Abstract
This research aimed to produce a coherent ranking of the effectiveness of intubation devices in pediatric patients using network meta-analysis (NMA). We searched the electric databases for prospective randomized studies that compared different tracheal intubation devices in pediatric patients. The primary outcome was [...] Read more.
This research aimed to produce a coherent ranking of the effectiveness of intubation devices in pediatric patients using network meta-analysis (NMA). We searched the electric databases for prospective randomized studies that compared different tracheal intubation devices in pediatric patients. The primary outcome was intubation failure at the first attempt. Secondary outcomes were glottic visualization and intubation time. The statistical analysis performed used DerSimonian and Laird random-effects models. Frequentist network meta-analysis was conducted, and network plots and network league tables were produced. Subgroup analysis was performed after excluding rigid-fiberscope-type indirect laryngoscopes. Thirty-four trials comparing 13 devices were included. Most laryngoscopes had the same intubation failure rate as the Macintosh reference device. Only the Truview PCD™ had a significantly higher intubation failure rate than the Macintosh (odds ratio 4.78, 95% confidence interval 1.11–20.6) The highest-ranking laryngoscope was the Airtaq™ (P score, 0.90), and the AirwayScope™, McGrath™, and Truview EVO2™ ranked higher than the Macintosh. The Bullard™ had the lowest ranking (P score, 0.08). All laryngoscopes had the same level of glottic visualization as the Macintosh and only the C-MAC™ had a significantly shorter intubation time. Intubation time was significantly longer when using the GlideScope™, Storz DCI™, Truview PCD™, or Bullard™ compared with the Macintosh. P score and ranking of devices in the subgroup analyses were similar to those in the main analysis. We applied NMA to create a consistent ranking of the effectiveness of intubation devices in pediatric patients. The findings of NMA suggest that there is presently no laryngoscope superior to the Macintosh laryngoscope in terms of tracheal intubation failure rate and glottic visualization in pediatric patients. Full article
(This article belongs to the Special Issue Pediatric Airway Management: Advances and Future Challenges)
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13 pages, 6110 KiB  
Article
Comparison of the UEscope Video Laryngoscope with the Traditional Direct Laryngoscope in Neonates and Infants: A Randomized Clinical Trial
by Min-Suk Chae, Jae-Hee Chung, Jung-Woo Shim, Jae-Sik Park, Jin-Hoon Bae and Hyung-Mook Lee
Children 2022, 9(8), 1161; https://0-doi-org.brum.beds.ac.uk/10.3390/children9081161 - 02 Aug 2022
Cited by 3 | Viewed by 1693
Abstract
The role of video laryngoscopy in adults is well established, but its role in children is still inconclusive. Previous studies on the UEscope in pediatric patients with difficult airways showed that it could reduce the time to intubation (TTI) compared to a conventional [...] Read more.
The role of video laryngoscopy in adults is well established, but its role in children is still inconclusive. Previous studies on the UEscope in pediatric patients with difficult airways showed that it could reduce the time to intubation (TTI) compared to a conventional direct laryngoscope. The main objective of the current study was to investigate if the use of the UEscope could reduce the TTI in neonates and infants. Forty patients under 12 months old were recruited from a single tertiary hospital from March 2020 to September 2021 and were randomly assigned to the direct laryngoscope group (n = 19, neonates = 4, infants = 15) or UEscope group (n = 21, neonates = 6, infants = 15). Although the quality of glottic view was comparable in both groups, the TTI was significantly lower in the UEscope group in both the “intention-to-treat” (–19.34 s, 95% confidence interval = –28.82 to –1.75, p = 0.0144) and “as treated” (–11.24 s, 95% confidence interval: –21.73 to 0, p = 0.0488) analyses. The UEscope may be a better choice for tracheal intubation than conventional direct laryngoscope in neonates and infants. Full article
(This article belongs to the Special Issue Pediatric Airway Management: Advances and Future Challenges)
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12 pages, 1388 KiB  
Study Protocol
Effect of Intermediate Airway Management on Ventilation Parameters in Simulated Pediatric Out-of-Hospital Cardiac Arrest: Protocol for a Multicenter, Randomized, Crossover Trial
by Loric Stuby, Elisa Mühlemann, Laurent Jampen, David Thurre, Johan N. Siebert and Laurent Suppan
Children 2023, 10(1), 148; https://0-doi-org.brum.beds.ac.uk/10.3390/children10010148 - 12 Jan 2023
Viewed by 1981
Abstract
Most pediatric out-of-hospital cardiac arrests (OHCAs) are caused by hypoxia, which is generally consecutive to respiratory failure. To restore oxygenation, prehospital providers usually first use basic airway management techniques, i.e., bag-valve-mask (BVM) devices. These devices present several drawbacks, most of which could be [...] Read more.
Most pediatric out-of-hospital cardiac arrests (OHCAs) are caused by hypoxia, which is generally consecutive to respiratory failure. To restore oxygenation, prehospital providers usually first use basic airway management techniques, i.e., bag-valve-mask (BVM) devices. These devices present several drawbacks, most of which could be avoided using supraglottic airway devices. These intermediate airway management (IAM) devices also present significant advantages over tracheal intubation: they are associated with higher success and lower complication rates in the prehospital setting. There are, however, few data regarding the effect of early IAM in pediatric OHCA. This paper details the protocol of a trial designed to evaluate the impact of this airway management strategy on ventilation parameters through a simulated, multicenter, randomized, crossover trial. The hypothesis underlying this study protocol is that early IAM without prior BVM ventilations could improve the ventilation parameters in comparison with the standard approach, which consists in BVM ventilations only. Full article
(This article belongs to the Special Issue Pediatric Airway Management: Advances and Future Challenges)
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