PEDIATRIC CONSIDERATIONS FOR SOAP ME & AIRWAY MANAGEMENT

SOAP ME:

Similar to adult patients, the same preparatory steps should be followed prior to pediatric airway intervention. There are, however, significant differences with respect to equipment requirements and provider skill level. The core principles of SOAP ME remain the same, with the following considerations:

- Suction – Similar to adults, ideally you can provide in-line suction, but you also will at a minimum need the correct size tubes to be able to provide suction
- Oxygen –Multiple sized nasal cannulas, face masks and BVMs may be required for infants and children.
- Airway – Multiple sizes of tubes are essential and proper pre-mission logistic planning includes pediatric supplies. Avoid surgical airway in <12 years old - use needle cricothyroidotomy (12-14 gauge).
- Pharmacy – Ensure you have a drug estimation guide, but always double check pediatric weight-based doses and measurements.
- Monitor/Machine – Continuous ventilation requires specific rate and volume based on the patient’s age/size. Ensure your ventilator can provide the required rate and volume prior to intubating or performing advanced procedures.1,2
- Equipment – Having pediatric sized equipment is essential as well as being able to adapt to pediatric sizes using adult monitors. Ensure you have pediatric sized needles with 24, 22, 20 and 18g as the primary access based on age of the patient. Pediatric intraosseous needles may be required.

ADDITIONAL EQUIPMENT

1. Broselow Tape or similar height-based treatment aids.3
2. Video Laryngoscopy (VL) – While this is frequently an adjunctive (better/best) consideration for adult airway management, in the case of pediatric airways, VL has been shown in studies to out-perform direct laryngoscopy.4-7
3. Pediatric Kit – Pediatric airway equipment should be pre-packaged and set apart to allow for a rapid inclusion or addition to baseline airway kits.

ESSENTIAL MEASUREMENTS AND FORMULAS

Unlike adult airways that are narrowest at the level of the vocal cords (and therefore visible during DL or VL) pediatric tracheas are narrowest at the infraglottic level (19). In consideration of this, the following formulas and treatment aids are presented to best estimate tube sizes and measurements:

1. ETT size: age/4 +3.5. 8
2. ETT insertion depth (for children over 1 year of age) in centimeters: age/2 + 13
3. ETT insertion depth (for children under 1 year of age) in centimeters: weight/2 + 8
4. Tidal volume: 5-8 cc/kg, rate concordant with pre-arrest breathing or rate prior to intervention. PALS recommends initial rate of at least 10-12 breaths/minute.1,2
5. Use caution with BVM, especially if improvising with adult BVM. Inflate gently only until the chest begins to rise.