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Pediatric Microlaryngoscopy and Bronchoscopy in the COVID-19 Era

Educational Objective
To understand how pediatric microlaryngoscopy and bronchoscopy techniques need to adjust during the COVID-19 pandemic
1 Credit CME
Key Points

Question  How should pediatric microlaryngoscopy and bronchoscopy techniques be altered during the COVID-19 era?

Findings  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.

Meaning  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.

Abstract

Importance  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.

Objective  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.

Exposures  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).

Results  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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Article Information

Accepted for Publication: April 20, 2020.

Corresponding Author: Katherine Pollaers, MBBS, MSurg, Perth Children’s Hospital, 15 Hospital Ave, Nedlands WA 6009, Australia (katherine.pollaers@gmail.com).

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.

References
1.
Gengler  I , Wang  J , Speth  M , Sedaghat  A .  Sinonasal pathophysiology of SARS-CoV-2 and COVID-19: a systematic review of the current evidence  [published online April 10, 2020].  Laryngoscope Investig Otolaryngol. doi:10.1002/lio2.384Google Scholar
2.
Zou  L , Ruan  F , Huang  M ,  et al.  SARS-CoV-2 viral load in upper respiratory specimens of infected patients.   N Engl J Med. 2020;382(12):1177-1179. doi:10.1056/NEJMc2001737PubMedGoogle ScholarCrossref
3.
World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations [scientific brief]. Accessed April 21, 2020. https://www.who.int/publications-detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations
4.
Tran  K , Cimon  K , Severn  M , Pessoa-Silva  CL , Conly  J .  Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review.   PLoS One. 2012;7(4):e35797. doi:10.1371/journal.pone.0035797PubMedGoogle Scholar
5.
American Academy of Otolaryngology–Head and Neck Surgery. Otolaryngologists and the COVID-19 pandemic. https://www.entnet.org/content/otolaryngologists-and-covid-19-pandemic
6.
Patel  ZM , Fernandez-Miranda  J , Hwang  PH ,  et al.  Letter: precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic  [published online April 15, 2020].  Neurosurgery. doi:10.1093/neuros/nyaa125PubMedGoogle Scholar
7.
Australian Government—Department of Health. COVID-19 cases in Australia by state and source of transmission. Accessed April 11, 2020. https://www.health.gov.au/resources/publications/covid-19-cases-in-australia-by-state-and-source-of-transmission
8.
Philpott  C , Burrows  S . Aerosol-generating procedures in ENT. Accessed April 21, 2020. https://www.entuk.org/aerosol-generating-procedures-ent
9.
Brewster  DJ , Chrimes  NC , Do  TBT ,  et al.  Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group  [published online April 1, 2020].  Med J Aust. https://www.mja.com.au/journal/2020/consensus-statement-safe-airway-society-principles-airway-management-and-trachealGoogle Scholar
10.
Frauenfelder  C , Butler  C , Hartley  B ,  et al.  Practical insights for paediatric otolaryngology surgical cases and performing microlaryngobronchoscopy during the COVID-19 pandemic.   Int J Pediatr Otorhinolaryngol. 2020;134(March):110030. doi:10.1016/j.ijporl.2020.110030PubMedGoogle Scholar
11.
Australasian Society for Infectious Diseases Limited. Interim guidelines for the clinical management of COVID-19 in adults. Accessed April 21, 2020. https://www.asid.net.au/documents/item/1873
12.
Australian Society of Otolaryngology Head and Neck Surgery. ASOHNS review of guidance for PPE for ENT surgeons during the COVID-19 pandemic. Accessed April 21, 2020. https://umbraco.surgeons.org/media/5189/asohns-updated-guidance-for-ppe-ent-surgeons-covid19-2020-04-02.pdf
13.
Lu  X , Zhang  L , Du  H ,  et al; Chinese Pediatric Novel Coronavirus Study Team.  SARS-CoV-2 infection in children [published online March 18, 2020].  N Engl J Med. doi:10.1056/NEJMc2005073PubMedGoogle Scholar
14.
Lu  D , Wang  H , Yu  R , Yang  H , Zhao  Y .  Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers.   J Hosp Infect. 2020;104(4):454-455. doi:10.1016/j.jhin.2020.02.018PubMedGoogle ScholarCrossref
15.
Vukkadala  N , Qian  ZJ , Holsinger  FC , Patel  ZM , Rosenthal  E .  COVID-19 and the otolaryngologist—preliminary evidence-based review  [published online March 26, 2020].  Laryngoscope. doi:10.1002/lary.28672PubMedGoogle Scholar
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