Objective: To review the steps involved in safe airway management in critically ill children.
Source of data: Review of articles selected through Medline until April 2003 using the following key words: intubation, children, sedation.
Summary of the findings: Airway compromise is rare, but whenever it occurs, the situation depends on professionals trained to carry out safe, early, and rapid airway management, with no harm to the patient. The method currently advocated for airway management is rapid sequence intubation, which requires preparation, sedation and neuromuscular block. We observed that it is not possible to apply one single intubation protocol to all cases, since the selection of the most adequate procedure depends on indication and patient conditions. We defined the drug doses most commonly used in our setting, since little is know so far about the real effect of sedatives and analgesics. In most situations, the association of an opioid (fentanyl at 5-10 micro g/kg) with a sedative (midazolam at 0.5 mg/kg) and a neuromuscular blocking agent are sufficient for tracheal intubation.
Conclusions: Training, knowledge, and skill in airway management are of fundamental importance for pediatric intensive caregivers and are vital for the adequate treatment of critically ill children. We present an objective and dynamic text aimed at offering a theoretical basis for the generation of new protocols, to be implemented according to the strengths and difficulties of each service.