Hospitals & Services
Most of our patients will be intubated prior to ICU arrival. For children who need intubating in the unit, a senior clinician with experience with the paediatric airway should be present. The ICU consultant on call should be informed if they are not already present. There are several differences to be aware of:
Physiology Young children readily become bradycardic in response to suxamethonium given for intubation; consideration should be given to pre-treatment with atropine (20mcg/kg, minimum 100mcg). An alternative to suxamethonium is 1mg/kg rocuronium for intubation. Children have higher metabolic rates than adults and lower FRC, and therefore desaturate rapidly. Pre oxygenation and rapid securement of the airway is therefore crucial – ensure you can bag-mask ventilate the child prior to giving a long acting relaxant for intubation. LMA's in appropriate sizes are also available in an emergency.
*ETT. A leak should be present with PPV. ETT can be uncuffed (usual) or cuffed (cuff usually left deflated) to ensure the right fit.
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