Practicing in Bangalore, India, Dr. Deepa Shivnani is an Otolaryngologist with advanced training in pediatric airway. During her practice, she realized the need for a non-invasive technique for the timely evaluation of pediatric airway disorders in the emergency department. In her experience, she has found that pediatric airway screening can be improved with point-of-care ultrasound (POCUS).
In September, attendees to the POCUS World Conference, hosted by the POCUS Certification Academy™, were given the opportunity to hear from Dr. Shivnani about the strengths of POCUS as a diagnostic tool versus those of traditional pediatric airway management devices. Her presentation established laryngeal ultrasonography as a valid approach for the operative management in children, specifically in cases of stridor. Ultrasound has the advantages of being simple, available, non-anesthetic, non-radiative, and non-invasive.
Pediatric airway evaluation is critical for safely and effectively managing airway lesions that present with stridor. The laryngeal lesions may cause symptoms ranging from hoarseness to severe obstruction of the airway. With such lesions, preliminary diagnosis and postoperative surveillance are difficult, particularly in the pediatric age group. The most common modality in stridor evaluation is laryngoscopy examination under anesthesia, which is time-consuming and has the added risks of anesthesia. “India is [also] a country with limited resources,” Dr. Shivnani explained in an interview. “The majority of tertiary care centers still do not have the flexible laryngoscope to examine the pediatric airway, but most of them will surely have the ultrasound machines.”
An added benefit of POCUS as a screening tool is its availability. The pocket-sized device can be kept on hand by clinicians at all times, allowing for immediate examination. Clinics with limited budgets may need to choose between highly-specialized tools and devices, such as ultrasound, that have a variety of purposes. POCUS’s versatility makes it a practical and cost-effective option.
The mobile device has proved vital in emergency care, but pediatric-specific data is limited.The differences between pediatric and adult medicine deal with more than just the patient’s size. Pediatrics deals with infants and adolescents whose bodies are still developing and who don’t necessarily understand the need for healthcare and examinations. “It is difficult to get cooperation from a child,” Dr. Shivnani said. “And sometimes parental anxiety comes in the way when they are hesitant for any invasive procedure for their child.”
She notes the value of POCUS in these situations. When a parent brings their child in for care because of breathing difficulties or suspicion of a compromised airway passage, the first step is to examine the child’s airway. However, radiology risks radiation exposure, and laryngoscopy may cause airway edema or other injuries to little patients. The natural hesitation from parents to allow such procedures—or even the lack of examination tools available to health providers—can cause fatal delays. Ultrasound is a non-invasive and readily available option that provides answers in real-time. Once the clinician identifies the pathology, the airway can be secured without further delay.
Because of its convenience and ease of use, Dr. Shivnani expects bedside ultrasound to one day become the foremost tool for pediatric airway evaluations. She notes that POCUS in pediatrics does require special training, and right now, due to the lack of a structured training program, the use of the tool in pediatrics is far less common than in adult medicine.
Through her breakout session, Dr. Shivnani demonstrated the benefits of POCUS in pediatric care and highlighted the need for continued study on its effectiveness. Pediatrics presents its own set of unique challenges to POCUS users, but the device could easily transform the field as it has others. Dr. Shivnani’s goal is to catalyze that transformation by educating physicians on bedside ultrasound’s limitless possibilities and helping primary care physicians in resource-limited countries evaluate children with breathing difficulties.
Want to learn more? Dr. Shivnani presented additional information on this topic during a webinar last year. Check it out here.