UMEM Educational Pearls

Category: Pediatrics

Title: Pediatric intubation (submitted by Danya Khoujah, MBBS)

Keywords: premedication, RSI, ventilator, high flow nasal cannula (PubMed Search)

Posted: 9/21/2012 by Mimi Lu, MD
Click here to contact Mimi Lu, MD

When intubating an infant, a few key points need to be kept in mind:
- Remember that the narrowest point is the cricoid, so even if the ETT passes the cords it might still not pass through the cricoid itself.
- Remember premedication with atropine is recommended in all children less that 1 year old and in those less than 5 years old when using succinylcholine. It is used to prevent reflex bradycardia and high ICP and to decrease secretions. The dose is 0.02 mg/kg IV, with a minimum of 0.1 mg and a max of 0.5 mg. Give it 2 full minutes before the start of intubation.
- Remember that succinylcholine is contraindicated in neuromuscular disease (including an undiagnosed myopathy). A slightly higher dose (2mg/kg) may need to be used in infants (compared to 1-1.5mg/kg in adults and older children).  
- Pressure control mode is preferred over volume control (VC) setting in peds, because VC tends to overestimate how much volume it's delivering, therefore delivering inadequate ventilation.
- Remember your alternatives: High Flow Nasal cannula (HFNC) can be used in infants with respiratory distress to avoid intbation. One study showed that is decreased intubation rates by 68% in respiratory distress due to bronchiolitis
1. Santillanes G, Gausche-Hill M. Pediatric Airway Management. Emerg Med Clin N Am 26 (2008) 961–975
2. Bledsoe G H, Schexnayder S M. Pediatric Rapid Sequence Intubation A Review. Ped Emerg Care 20 (2004) 339-344