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Matava CT, Kovatsis PG, Summers JL, Castro P, Denning S, Yu J, Lockman JL, Von Ungern-Sternberg B, Sabato S, Lee LK, Ayad I, Mireles S, Lardner D, Whyte S, Szolnoki J, Jagannathan N, Thompson N, Stein ML, Dalesio N, Greenberg R, McCloskey J, Peyton J, Evans F, Haydar B, Reynolds P, Chiao F, Taicher B, Templeton T, Bhalla T, Raman VT, Garcia-Marcinkiewicz A, Gálvez J, Tan J, Rehman M, Crockett C, Olomu P, Szmuk P, Glover C, Matuszczak M, Galvez I, Hunyady A, Polaner D, Gooden C, Hsu G, Gumaney H, Pérez-Pradilla C, Kiss EE, Theroux MC, Lau J, Asaf S, Ingelmo P, Engelhardt T, Hervías M, Greenwood E, Javia L, Disma N, Yaster M, Fiadjoe JE. Pediatric Airway Management in COVID-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society. Anesth Analg 2020; 131:61-73. [PMID: 32287142 PMCID: PMC7173403 DOI: 10.1213/ane.0000000000004872] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 12/14/2022]
Abstract
The 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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Affiliation(s)
- Clyde T. Matava
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pete G. Kovatsis
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
| | - Jennifer Lee Summers
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Pilar Castro
- Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio
| | - Simon Denning
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Yu
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Justin L. Lockman
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Stefano Sabato
- Department of Anaesthesia and Pain Management, The Royal Children’s Hospital, Victoria, Australia
| | - Lisa K. Lee
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
| | - Ihab Ayad
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
| | - Sam Mireles
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
| | - David Lardner
- Department of Anesthesia, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Simon Whyte
- Department of Anesthesiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Judit Szolnoki
- Department of Anesthesiology; University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
| | | | - Nicole Thompson
- Department of Anesthesiology, Shriners Hospitals for Children, Chicago, Illinois
| | - Mary Lyn Stein
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nicholas Dalesio
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Robert Greenberg
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - John McCloskey
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - James Peyton
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia
- Department of Anaesthesia and Pain Management, The Royal Children’s Hospital, Victoria, Australia
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
- Department of Anesthesia, Alberta Children’s Hospital, Calgary, Alberta, Canada
- Department of Anesthesiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Department of Anesthesiology; University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
- Department of Anesthesiology, Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Anesthesiology, Shriners Hospitals for Children, Chicago, Illinois
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
- Department of Anesthesiology, Duke University, Durham, North Carolina
- Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest, North Carolina
- Department of Anesthesiology and Pain Medicine, Akron Children’s Hospital, Northeast Ohio Medical University, Akron, Ohio
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
- Department of Anesthesia, Hospital Son Espases, Illes Balears, Spain
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology, Instituto de Ortopedia Infantil Roosevelt, Bogotá, Colombia
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
- Department of Anesthesiology and Pediatrics, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Anesthesiology, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Anesthesiology, Arkansas Children’s Hospital & University of Arkansas & Medical Science Center, Little Rock, Arkansas
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
- /label>Pediatric Anesthesia Unit, Cardiac and Neonatal Section, Gregorio Marañón University Hospital, Madrid, Spain
- Department of Otorhinolaryngology Head and Neck Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Faye Evans
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
| | - Bishr Haydar
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
| | - Paul Reynolds
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
| | - Franklin Chiao
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Brad Taicher
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Thomas Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest, North Carolina
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Akron Children’s Hospital, Northeast Ohio Medical University, Akron, Ohio
| | - Vidya T. Raman
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
| | | | - Jorge Gálvez
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan Tan
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mohamed Rehman
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christy Crockett
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Patrick Olomu
- Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas
| | - Peter Szmuk
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Chris Glover
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Maria Matuszczak
- Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
| | - Ignacio Galvez
- Department of Anesthesia, Hospital Son Espases, Illes Balears, Spain
| | - Agnes Hunyady
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - David Polaner
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Cheryl Gooden
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Grace Hsu
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Harshad Gumaney
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Edgar E. Kiss
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
| | - Mary C. Theroux
- Department of Anesthesiology and Pediatrics, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Lau
- Department of Anesthesiology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Saeedah Asaf
- Department of Anesthesiology, Arkansas Children’s Hospital & University of Arkansas & Medical Science Center, Little Rock, Arkansas
| | - Pablo Ingelmo
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
| | - Thomas Engelhardt
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
| | - Mónica Hervías
- /label>Pediatric Anesthesia Unit, Cardiac and Neonatal Section, Gregorio Marañón University Hospital, Madrid, Spain
| | - Eric Greenwood
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Luv Javia
- Department of Otorhinolaryngology Head and Neck Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nicola Disma
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Myron Yaster
- Department of Anesthesiology, Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - John E. Fiadjoe
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
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