Airway management remains the single highest risk time for our patients in pediatric ICU.  Different studies of pediatric airway management report first pass success as low as 50%. Rates of severe desaturation as high as 20%, and significant rates of cardiac arrest ranging from two to 15% in the 30 minute peri intubation window alone. A difficult airway might be anticipated or unanticipated and is not just difficult endotracheal intubation, but also difficulties with mask ventilation. supraglottic airway devices, difficult rescue techniques including front of neck access and physiologically difficult airways, which we covered in previous episodes. 

The good news is that the attention our community has been paying to these issues has reduced the rates of endo tracheal intubation (ETI) associated adverse events significantly, but there's still a long way to go. We are joined by Akira Nishisaki from NEAR 4 Kids & CHOP which has been one of the main drivers of improvements in this space for almost 20 years and who has an incredible knowledge of the literature and Doug Atkinson a pediatric anesthesiologist and cardiac intensivist from Boston Children's Hospital.

As always, we focus on how our expert panel do things in practice at their institutions whilst being aware of the evidence.