Pediatric laryngoscopy and bronchoscopy during the COVID-19 pandemic: A four-center collaborative protocol to improve safety with perioperative management strategies and creation of a surgical tent with disposable drapes

Christian R Francom; Luv R Javia; Nikolaus E Wolter; Gi Soo Lee; Todd Wine; Tyler Morrissey; Blake C Papsin; James M Peyton; Clyde T Matava; Mark S Volk; Jeremy D Prager; Evan J Propst

doi:10.1016/j.ijporl.2020.110059

Pediatric laryngoscopy and bronchoscopy during the COVID-19 pandemic: A four-center collaborative protocol to improve safety with perioperative management strategies and creation of a surgical tent with disposable drapes

Int J Pediatr Otorhinolaryngol. 2020 Jul:134:110059. doi: 10.1016/j.ijporl.2020.110059. Epub 2020 Apr 21.

Authors

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA. Electronic address: Christian.francom@childrenscolorado.org.
² Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
³ Department of Otolaryngology, Head and Neck Surgery, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
⁴ Department of Otolaryngology, Head and Neck Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
⁵ Department of Otolaryngology, Head and Neck Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA.
⁶ Department of Anesthesiology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, CO, USA.
⁷ Department of Anesthesiology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.
⁸ Department of Anesthesia and Pain Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Canada.

Abstract

Aerosolization procedures during the COVID-19 pandemic place all operating room personnel at risk for exposure. We offer detailed perioperative management strategies and present a specific protocol designed to improve safety during pediatric laryngoscopy and bronchoscopy. Several methods of using disposable drapes for various procedures are described, with the goal of constructing a tent around the patient to decrease widespread contamination of dispersed droplets and generated aerosol. The concepts presented herein are translatable to future situations where aerosol generating procedures increase risk for any pathogenic exposure. This protocol is a collaborative effort based on knowledge gleaned from clinical and simulation experience from Children's Hospital Colorado, Children's Hospital of Philadelphia, The Hospital for Sick Children in Toronto, and Boston Children's Hospital.

Keywords: Aerosol generating procedures; Bronchoscopy; COVID-19; Coronavirus; Droplet; Laryngoscopy; Pediatric airway; Precaution; SARS CoV2; Suspension.

Publication types

Multicenter Study

MeSH terms

Betacoronavirus*
Bronchoscopy*
COVID-19
Child
Clinical Protocols
Coronavirus Infections / prevention & control*
Humans
Laryngoscopy*
Pandemics / prevention & control*
Perioperative Period
Pneumonia, Viral / prevention & control*
SARS-CoV-2