Mar 09, 2015 · Pediatric vs Adult Airway. Posted March 9, 2015 by Jeff Simpson. Pediatric vs Adult Airway. From time to time all ACLS, PALS and BLS providers with airway management responsibilities, emergent or routine, will encounter the pediatric patient and be called upon to manage a pediatric airway. It’s challenging to open the airway of such a small infant when adult fingers dwarf the size of the baby’s mouth and all of the instruments are smaller. And babies are fragile, with little reserve.
Normal Pediatric Airway Anatomy and Physiology. Pediatric patients consume more oxygen (6-8 mL/kg/hr), compared to 2-3 mL/kg/hr in adults. In addition to a lower FRC (22 mL/kg vs 34 mL/kg), 1/2 the number of alveoli, and 1/20th the surface area for gas exchange, pediatric patients are more likely to desaturate faster. Laryngeal position. By the time a child is 2 years old, the larynx and cricoid have descended to C3-C4. The infant and pediatric larynx is in a more anterior position, and distances between the tongue, hyoid bone, epiglottis, and other oral structures are smaller than in an adult. In adults, the laryngeal opening is opposite the C5-C6 interspace.
The net result in an infant with a 4-mm diameter airway is a 75% reduction in cross-sectional area and a 16-fold increase in resistance to laminar airflow, compared with a 44% reduction in cross-sectional area and a 3-fold increased resistance in an adult with a similar 2-mm reduction in airway diameter.