Airway suction, oxygen devices and nebuliser technique

Overview & Definition

A wheezy, struggling infant, a child who has vomited and is unconscious, and a toddler with an asthma attack all need the same three hands-on skills: clear the airway of whatever is blocking it, give the right amount of oxygen to a chosen target, and deliver a drug as a mist that actually reaches the lung. These skills — airway suction, oxygen devices, and nebuliser technique — are bundled as one topic because they are done together, at the bedside, in the first minutes of caring for a sick child, and because the same physics decides whether each of them works.

[2]

Each skill rests on a single idea. Suction removes liquid from the airway so gas can flow again. Oxygen therapy adds oxygen, but how much actually reaches the alveolus depends on the device and on how hard the child is breathing. A nebuliser turns a liquid drug into droplets, and the size of those droplets decides whether the drug lands in the mouth or travels down to the small airways where it acts. Get one idea wrong and the whole effort is wasted, which is why these procedures reward understanding over ritual. [6]

References12Show ledgerHide ledger

1. [1]Franklin D A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. N Engl J Med, 2018.PMID 29562151
2. [2]Alexander EC Effectiveness of high flow nasal Cannula (HFNC) therapy compared to standard oxygen therapy (SOT) and continuous positive airway pressure (CPAP) in bronchiolitis. Paediatr Respir Rev, 2024.PMID 38937210
3. [3]Ramnarayan P High-flow nasal cannula therapy versus continuous positive airway pressure for non-invasive respiratory support in paediatric critical care: the FIRST-ABC RCTs. Health Technol Assess, 2025.PMID 40326538
4. [4]Cates CJ Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev, 2013.PMID 24037768
5. [5]Hamud AA Use of inhaled/nebulised ipratropium bromide in addition to standard first-line treatment with inhaled/nebulised short-acting beta 2-agonist and systemic steroid in the management of acute asthma exacerbations: a systematic review and meta-analysis of randomised controlled trials. Arch Dis Child, 2026.PMID 41224524
6. [6]Trend S Current options in aerosolised drug therapy for children receiving respiratory support. Anaesthesia, 2017.PMID 28872662
7. [7]MacLoughlin R Vibrating Mesh and Jet Nebulizer Performance in Pediatric Respiratory Support: A Multi-Modality In Vitro Comparison. Pharmaceutics, 2026.PMID 42198269
8. [8]Peters MJ Conservative versus liberal oxygenation targets in critically ill children (Oxy-PICU): a UK multicentre, open, parallel-group, randomised clinical trial. Lancet, 2024.PMID 38048787
9. [9]Subhi R When should oxygen be given to children at high altitude? A systematic review to define altitude-specific hypoxaemia. Arch Dis Child, 2009.PMID 18829620
10. [10]Zulqarnain A Continuous versus intermittent nebulization of salbutamol in acute Severe asthma in children under 12 years of age. Pak J Med Sci, 2026.PMID 41737184
11. [11]Ringer CN Physiologic Effects of Nasal Aspiration and Nasopharyngeal Suctioning on Infants With Viral Bronchiolitis. Respir Care, 2020.PMID 32071129
12. [12]Le Roch M Iatrogenic mediastinitis in bronchiolitis: Importance of avoiding pharyngeal aspiration. Arch Pediatr, 2019.PMID 31278025