The Pediatric Airway Smaller and more flexible than an adult. Tongue proportionately larger. Epiglottis floppy and round. Glottic opening higher and more anterior. Vocal cords slant upward, and are closer to the base of the tongue. Narrowest part is the cricoid cartilage.
Measuring Oxygen and Carbon Dioxide Levels Partial pressure is the pressure exerted by each component of a gas mixture. Partial pressure of a gas is its percentage of the mixture’s total pressure.
Diffusion Movement of a gas from an area of higher concentration to an area of lower concentration. Diffusion transfers gases between the lungs and the blood and between the blood and peripheral tissues.
Oxygen Concentration in the BloodOxygen saturation = O2 content/ O2 capacity x 100%
Factors Affecting OxygenConcentration in the Blood Decreased hemoglobin concentration. Inadequate alveolar ventilation. Decreased diffusion across the pulmonary membrane when diffusion distance increases or the pulmonary membrane changes. Ventilation/perfusion mismatch occurs when a portion of the alveoli collapses.
Inadequate minute volumerespirations can compromise adequate oxygen intake and carbon dioxide removal.
Factors Affecting Carbon Dioxide Concentrations in the Blood (1 of 2) Hyperventilation lowers CO2 levels due to increased respiratory rates or deeper respiration. Causes of increased CO2 production include: Fever, muscle exertion, shivering, metabolic processes resulting in the formation of metabolic acids.
Factors Affecting Carbon Dioxide Concentrations in the Blood (2 of 2) Decreased CO2 elimination results from decreased alveolar ventilation. Respiratory depression, airway obstruction, respiratory muscle impairment, obstructive diseases.
Nervous Impulses from the Respiratory Center Main respiratory center is the medulla. Neurons within medulla initiate impulses that produce respiration. Apneustic center assumes respiratory control if the medulla fails to initiate impulses. Pneumotaxic center controls respiration.
Stretch ReceptorsThe Hering-Breuer reflexprevents over-expansion of the lungs.
Chemoreceptors Located in carotid bodies, arch of the aorta, and medulla. Stimulated by decreased PaO2, increased PaCO2, and decreased pH. Cerebrospinal fluid (CSF) pH is primary control of respiratory center.
Hypoxic Drive Hypoxemia is a profound stimulus of respiration in a normal individual. Hypoxic drive increases respiratory stimulation in people with chronic respiratory disease.
Ventilation of Pediatric Patients Mask seal can be more difficult. Bag size depends on age of child. Ventilate according to current standards. Obtain chest rise and fall with each breath. Assess adequacy of ventilations by observing chest rise, listening to lung sounds, and assessing clinical improvement.
Direct visualization of the larynx with a laryngoscopemay enable the removal of an obstructing foreign body.
Foreign body removal with directvisualization and Magill forceps
Suctioning Anticipating complications when managing an airway is the key for successful outcomes. Be prepared to suction all airways to remove blood or other secretions and for the patient to vomit.
Suctioning Techniques Wear protective eyewear, gloves, and face mask. Preoxygenate the patient. Determine depth of catheter insertion. With suction off, insert catheter. Turn on suction and suction while removing catheter (no more than 10 seconds). Hyperventilate the patient.
ETT, Stylet, and Syringe,assembled for intubation
Disadvantages of Endotracheal Intubation Requires considerable training and experience. Requires specialized equipment. Requires direct visualization of vocal cords. Bypasses upper airway’s functions of warming, filtering, and humidifying the inhaled air.
Endotracheal Intubation Indicators Respiratory or cardiac arrest. Unconsciousness. Risk of aspiration. Obstruction due to foreign bodies, trauma, burns, or anaphylaxis. Respiratory extremis due to disease. Pneumothorax, hemothorax, hemopneumothorax with respiratory difficulty.
Complications of Endotracheal Intubation Equipment malfunction Teeth breakage and soft tissue lacerations Hypoxia Esophageal intubation Endobronchial intubation Tension pneumothorax
Advantages of Endotracheal Intubation Isolates trachea and permits complete control of airway. Impedes gastric distention. Eliminates need to maintain a mask seal. Offers direct route for suctioning. Permits administration of some medications.
Nasotracheal intubation maybe useful in some situations: Possible spinal injury Clenched teeth Fractured jaw, oral injuries, or recent oral surgery Facial or airway swelling Obesity Arthritis preventing sniffing position