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Airway management and anatomical development of the pediatric aerodigestive tract (ADT): current knowledge and clinical applications

Pediatric airway management can be difficult and especially hazardous due to a number of anatomical features of the developing aerodigestive tract (ADT), which is so different from the adult. Such differences have been presented annually since 2013 at EB meetings (Micham and Laitman, 2013; Curcio et al., 2014; Curcio and Laitman, 2015; Meaike et al., 2016; Gupta et al., 2016; Curcio et al., 2017, Curcio and Laitman, 2018). Particularly in regards to clinical applications involved in airway management procedures, our attention has been drawn to bedside tests that have been used to predict difficult intubation and difficult laryngoscopy in infants and young children. In stage 1 of this study we compiled a multi‐field database review of the mostly used bedside tests that predict difficult intubation of infants under 5 months of post‐natal life. We verified that ease of tracheal tube passage depends on the size of the cricoid ‐ the circular or near circular cartilage located at the inferior most portion of the funnel‐shaped infant larynx. We also selected the Laryngoscore (Piazza et al. 2014; 2018; Incandela et al, 2018), the frontal plane to chin distance, and the FPCD/weight ratio (Mansano et al., 2016) to be included in the next stages of this study. Our hypothesis is that it might be possible to adapt and increase the accuracy of such bedside tests and protocols that predict difficult intubation and laryngoscopy in infants and young children. This study is part of a larger project designed by our Brazilian‐US joint research team that seeks to explore possibilities and optimize airway management in elective procedures, critical and emergency care of pediatric patients under 5 months of age.