Elsevier

Critical Care Clinics

Volume 16, Issue 3, 1 July 2000, Pages 489-504
Critical Care Clinics

PEDIATRIC AIRWAY ISSUES

https://doi.org/10.1016/S0749-0704(05)70126-3Get rights and content
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The pediatric airway differs from the adult airway in many aspects. In children, the larynx is positioned more cephalad and the anterior attachment of the vocal cords is more inferior than the posterior attachment. This produces an anterocaudal angulation. The narrowest portion of the pediatric airway is the subglottic region. Another important consideration is that the tongue is relatively large, which makes airway obstruction a genuine concern. Infants and young children have a protuberant occiput, which may cause excessive neck flexion. Also, congenital abnormalities, their impact on anatomic position and structure of the airway, and the common occurrence of foreign body aspiration by children are unique issues related to the pediatric airway. Understanding these differences is inherent to managing the pediatric airway successfully.35, 75

Recently, there have been exciting new advances in the care of the critically ill pediatric patient and in issues related to pediatric airway management. These include uses of the laryngeal mask airway (LMA) and the cuffed oropharyngeal airway (COPA), radiologic evaluation of the pediatric airway, current management of croup, and the decreasing incidence of epiglottitis. Other topics recently reported in the literature include steroid use in postextubation stridor and management of the airway and ventilation strategies in pediatric burn patients.

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Address reprint requests to Richard J. Levy, MD, Department of Pediatric Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104–4283