Transtracheal Needle Ventilation

Abstract

For detailed descriptions of the anatomy of the adult larynx and trachea, please refer to surgical anatomy in Chapter 3: Open Tracheostomy and Chapter 4: Cricothyroidotomy. There are anatomical differences between the adult and pediatric airway that merit emphasis. In children less than 10–12 years of age the airway is small and the cartilaginous prominences can be subtle on palpation. Some anatomical features in children, such as larger tongue/mouth ratio, smaller pharynx, larger floppy epiglottis, anterior vocal cords/larynx, narrower cricoid cartilage, and softer tracheal rings, make endotracheal intubation more difficult than in adults. In older children and adolescents, the laryngeal prominence at the upper border of the thyroid cartilage is easily felt, with the cricothyroid membrane palpated immediately inferior to the thyroid cartilage. In infants and younger children, the laryngeal prominence is not developed, and the thyroid cartilage is not easily identified. A better method to identify the cricothyroid membrane is to begin at the tracheal rings and palpate superiorly to locate the prominence of the cricoid cartilage. The cricothyroid membrane resides superiorly. If the cricothyroid membrane cannot be identified, percutaneous transtracheal needle ventilation (TTNV) can be safely performed by inserting the needle between the tracheal rings.