Question about Pediatric Airway

[DavesNotHere]

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Reading the newest version of Baby Miller. States something along the lines of:
"though previously thought to be the cricoid ring, recent MRI studies have shown that the narrowest portion is glottis on pediatric patients, just like adults"

I only have the text book, so all my knowledge is academic (if that ) so I was wondering if this were true...and if yes/no if it has any clinical significance?

Thanks!

 

[IlDestriero]

Reading the newest version of Baby Miller. States something along the lines of:
"though previously thought to be the cricoid ring, recent MRI studies have shown that the narrowest portion is glottis on pediatric patients, just like adults"

I only have the text book, so all my knowledge is academic (if that ) so I was wondering if this were true...and if yes/no if it has any clinical significance?

Thanks!

That's not exactly correct, and typical of a shady handbook. It's not all that uncommon to intubate a young child and see the tube easily pass through the true cords only to meet significant resistance distal to the cords, at the level of the cricoid ring. There were 2 articles confirming that the narrowest part of the pediatric airway in a paralyzed child is at the level of the true cords, BUT the cords can expand to be wider than the cricoid ring. The cricoid ring is still the narrowest portion of the larynx. It is also useful to know that the cricoid ring is not circular, but elliptical. That's important to know as the use of a "properly sized" uncuffed tube with a minimal leak might still be causing significant compression leading to edema or even ischemia on the tissue at the level of the cricoid. It was long believed that uncuffed tubes were safer in pediatrics. The literature on the shape of the pediatric airway would suggest that a cuffed ETT might actually be safer, as it wouldn't be creating excessive pressure on the cricoid ring. I'm sure the "only uncuffed tubes in Peds" dogma is alive and well and widely practiced. We rarely used uncuffed tubes at any of the pediatric hospitals where I worked or trained. I use low pressure high volume Kimberly Clark Microcuff tubes when I'm doing cases on babies. The position of the cuff on pediatric tubes is highly variable and they usually don't have the low pressure cuff shape common on adult sized ETTs. Some (most?) are elliptical shaped and actually create a narrow high pressure ring seal. Not exactly what you want when you're trying to avoid airway edema/injury in a pediatric airway.

 

[DavesNotHere]

Great answer. Thanks!

 

[dhb]

It's not all that uncommon to intubate a young child and see the tube easily pass through the true cords only to meet significant resistance distal to the cords, at the level of the cricoid ring.

How much do you think this is due to the diameter of the trachea vs the anatomy? in some occasion i think the tube which is curved upwards is bouncing on the anterior trachea/cartilage since it doesn't follow the airway anatomy.