Management of the Unexpected Difficult Airway in Neonatal Resuscitation.

Gazmend Berisha,Anne Marthe Boldingh,Anne Lee Solevåg,Arild Erlend Rønnestad,Elin Wahl Blakstad

doi:10.3389/fped.2021.699159

Gazmend Berisha, Anne Marthe Boldingh + Show 3 more

Open Access

https://doi.org/10.3389/fped.2021.699159

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Abstract

A “difficult airway situation” arises whenever face mask ventilation, laryngoscopy, endotracheal intubation, or use of supraglottic device fail to secure ventilation. As bradycardia and cardiac arrest in the neonate are usually of respiratory origin, neonatal airway management remains a critical factor. Despite this, a well-defined in-house approach to the neonatal difficult airway is often lacking. While a recent guideline from the British Pediatric Society exists, and the Scottish NHS and Advanced Resuscitation of the Newborn Infant (ARNI) airway management algorithm was recently revised, there is no Norwegian national guideline for managing the unanticipated difficult airway in the delivery room (DR) and neonatal intensive care unit (NICU). Experience from anesthesiology is that a “difficult airway algorithm,” advance planning and routine practicing, prepares the resuscitation team to respond adequately to the technical and non-technical stress of a difficult airway situation. We learned from observing current approaches to advanced airway management in DR resuscitations in a university hospital and make recommendations on how the neonatal difficult airway may be managed through technical and non-technical approaches. Our recommendations mainly pertain to DR resuscitations but may be transferred to the NICU environment.

Highlights

5% of newborns need respiratory support such as positive pressure ventilation (PPV) to successfully overcome the phase from fetal to extrauterine life
Experience from anesthesiology is that algorithms, advance planning and routine practicing of a difficult airway approach optimize team responses to the technical and non-technical requirements of such situations [5]
Tracheal tube introducers (TTI) called gum elastic bougies are ‘difficult airway’ devices that are used as airway exchange introducers and to facilitate both intubation and extubation [28]. Both TTIs and stylets have proven to be useful in the management of difficult airways in adults where early application is recommended [29]

Summary

INTRODUCTION

5% of newborns need respiratory support such as positive pressure ventilation (PPV) to successfully overcome the phase from fetal to extrauterine life. The pharyngeal and laryngeal inlet must be achieved to avoid airway obstruction in the neonate during mask ventilation and to optimize the view of the laryngeal inlet during intubation. This can often be achieved by placing a towel roll under the shoulders to obtain a neutral position of the head and neck. Experience from anesthesiology is that algorithms, advance planning and routine practicing of a difficult airway approach optimize team responses to the technical and non-technical requirements of such situations [5]. No pre-medication was given in any of the DR intubations (Table 1)

REVIEW OF THE LITERATURE

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