Airway Management in Patients With Abnormal Anatomy or Challenging Physiology

Most pediatric intubations that occur in the emergency department are in patients without identifiable risk factors for difficulty. Infants and children go through a predictable pattern of development that impacts airway management. A careful, stepwise approach to the identification of the truly difficult pediatric airway is critical to avoid morbidity and mortality. Difficulty can be encountered in cases of challenging anatomy such as congenital airway or midface abnormalities or with acquired conditions such as croup or epiglottitis. Physiologically, intrinsic lung disease (ie, asthma) and shock states have unique features that impact airway management.