Pediatric Microlaryngoscopy and Bronchoscopy in the COVID-19 Era

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. 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. This case series study describes a modified technique for pediatric microlaryngoscopy and bronchoscopy for use in the COVID-19 era.