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How should pediatric microlaryngoscopy and bronchoscopy techniques be altered during the COVID-19 era?
A case series of 8 pediatric patients underwent microlaryngoscopy and bronchoscopy using techniques to minimize and contain aerosolized respiratory secretions during the procedure, including covering the patient with a plastic sheet, avoidance of direct laryngoscopy, early intubation with a cuffed tube, and modifications to interventions, such as supraglottoplasty. The techniques were used successfully, and no adverse events occurred.
Modified microlaryngoscopy and bronchoscopy techniques were associated with satisfactory patient outcomes and theoretically are associated with reduced risk to the otolaryngology theater team during the COVID-19 pandemic.
As an aerosol-generating procedure, traditional pediatric microlaryngoscopy and bronchoscopy techniques must be adapted in order to reduce the risk of transmission of severe acute respiratory syndrome coronavirus 2.
To describe a modified technique for pediatric microlaryngoscopy and bronchoscopy for use in the COVID-19 era and present a case series of patients for whom the technique has been used.
Design, Setting, and Participants
Observational case series of pediatric patients undergoing emergency or urgent airway procedures performed at a tertiary pediatric otolaryngology department in Australia. Procedures were completed between March 23 and April 9, 2020, with a median (range) follow-up of 24.5 (11-28) days.
Modified technique for microlaryngoscopy and bronchoscopy, minimizing aerosolization of respiratory tract secretions.
Main Outcomes and Measures
The main outcome was the feasibility of technique, which was measured by ability to perform microlaryngoscopy and bronchoscopy with comparable success to the usual technique (ie, adequate examination of the patient for diagnostic procedures and ability to perform interventional procedures).
The technique was used successfully in 8 patients (median [range] age, 160 days [27 days to 2 years 6 months]); 5 patients were male, and 3 were female. Intervention was performed on 6 patients; 2 balloon dilations for subglottic stenosis, 2 injections of hyaluronic acid for type 1 clefts, and 2 cold-steel supraglottoplasties. No adverse events occurred.
Conclusions and Relevance
In this case series, feasibility of a modified technique for pediatric microlaryngoscopy and bronchoscopy was demonstrated. By reconsidering the surgical approach in light of specific COVID-19 infection risks, this technique may be associated with reduced spread of aerosolized respiratory secretions perioperatively and intraoperatively, but the technique and patient outcomes require further study.
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Accepted for Publication: April 20, 2020.
Corresponding Author: Katherine Pollaers, MBBS, MSurg, Perth Children’s Hospital, 15 Hospital Ave, Nedlands WA 6009, Australia (firstname.lastname@example.org).
Published Online: April 28, 2020. doi:10.1001/jamaoto.2020.1191
Author Contributions: Dr Pollaers had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Pollaers, Vijayasekaran.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Pollaers, Vijayasekaran.
Critical revision of the manuscript for important intellectual content: Herbert, Vijayasekaran.
Statistical analysis: Vijayasekaran.
Administrative, technical, or material support: Herbert, Vijayasekaran.
Study supervision: Herbert, Vijayasekaran.
Conflict of Interest Disclosures: None reported.
Disclaimer: The views expressed in this article are the views of the authors and not an official position of the institution.
Additional Contributions: We thank the patient for granting permission to publish the clinical photographs.
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