Airway ultrasound: Point of care in children—The time is now

Abstract

Background Point‐of‐care ultrasonography of the airway is becoming a first‐line noninvasive adjunct assessment tool of the pediatric airway. It is defined as a focused and goal‐directed portable ultrasonography brought to the patient and performed and interpreted on the spot by the provider. Successful use requires a thorough understanding of airway anatomy and ultrasound experience. Aims To outline the many benefits, and some limitations, of airway ultrasonography in the clinical and perioperative setting. Materials and Methods Expert review of the recent literature. Results Ultrasound assessment of the airway may provide the clinician with valuable information that is specific to the individual airway static and dynamic anatomy of the patient. Ultrasound can help identify vocal cord dysfunction and pathology, assess airway size, predict the appropriate diameter of endotracheal and tracheostomy tubes, differentiate tracheal from esophageal intubation, localize the cricothyroid membrane for emergency airway access and identify tracheal rings for US‐guided tracheostomy. Ultrasonography is also a great tool for the intraoperative diagnosis of a pneumothorax, the visualization of the movement of the diaphragms, and quantifying the amount of gastric content. Ultrasonography signs, tips, and pearls that allow these diagnoses are highlighted. The major disadvantage of ultrasonography remains interobserver variability, and operator dependence, as it requires specific training and experience. Conclusion Although it is not standard of care yet, there is significant potential for the integration of ultrasound technology into the routine care of the airway.

Point-of-Care Ultrasound in the Pediatric Intensive Care Unit

“…Airway ultrasound is a novel point of care application in pediatric critical care ( 86 ). Clinicians are often challenged with questions such as vocal cord dysfunction, prediction of post-extubation stridor, anticipation of a difficult airway, and correct size and depth of endotracheal tube placement that are inadequately answered by current imaging or require invasive procedures.…”

The Role of Lung Ultrasound in the Management of the Critically Ill Neonate—A Narrative Review and Practical Guide

“…Ultrasound can play an important role in the diagnosis of vocal cord palsy and laryngomalacia without exposing the child to the risks of an invasive endoscopy [25,26].…”

Without training, they lacked knowledge. Without knowledge, they lacked confidence. Without confidence, they lacked victory (Julius Caesar)

“…Data sharing is not applicable to this article as no new data were created or analyzed in this study. Sam J. Daniel 1,2 Britta S. von Ungern-Sternberg 3,4,5 Pablo Ingelmo 2,6…”

“…In select cases, point of care ultrasound can also be a valuable adjunct for a rapid noninvasive sono-anatomy assessment of the airway. 5 Now it is to us to train and supervise our junior staff appropriately to make this common airway procedure safe with optimal patient outcomes.…”