Emergency intubation of children outside of the operating room

Abstract

Intubation of children outside of the operating room is performed infrequently and is often associated with life‐threatening adverse events. This review aims to clarify the contributors to adverse events encountered during intubations outside of the operating room and provide preventative strategies. The primary contributors to adverse events during non‐operating room intubations are physiologically and situationally difficult airways; anatomically difficult airways are rare. Systems‐based changes, including a shared mental model, standardization in equipment and its location, checklist use, physiological resuscitation prior to resuscitation, dose titration of induction agent, multi‐disciplinary team training in the technical and nontechnical aspects of non‐operating room intubation, debrief post–real and simulated events, and regular audit of performance all reduce life‐threatening intubation‐related adverse events in children. Intubation of children outside of the operating room may be performed safely through engagement of all critical care specialties, shared learning, and focus on patient‐centered care delivery.

Association Between Repeated Tracheal Intubation Attempts and Adverse Events in Children in the Emergency Department

“…25 Furthermore, recent studies have also underscored the importance of early and systematic employment of rescue airway approaches (eg, intubation methods, adjuncts, alternative intubators), [26][27][28][29] which help ED providers limit the number of attempt during intubation efforts. Particularly in the ED that has a small number of pediatric intubations, it is imperative to use systems-based approach, such as the use of check list, standardization in equipment and mediations, preintubation physiological resuscitation, and multidisciplinary team training, 30 which will, in turn, maximize the first-pass success rate and achieve safer airway management practice in the ED.…”

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

“…Bei Kindern sind schwierige Atemwege aufgrund der Anatomie selten anzutreffen, sondern entstehen gewöhnlich durch physiologische und situative Schwierigkeiten (z. B. mangelnde Vorbereitung; [ 158 ]). Die Bedingungen können durch Standardisierung der Ausrüstung und ihrer Anwendung, Verwendung von Checklisten, multidisziplinäre Teamschulungen in technischen und nichttechnischen Aspekten der Notfallintubation und regelmäßige Leistungsüberprüfungen optimiert werden.…”

An analysis of a new rapid difficult airway response team in a vertically built children's hospital

“…3 Additionally, the emerging concept of a physiologically difficult airway involves compromising patient factors such as fluid balance and hemodynamics, medication administration including induction technique, delays in intubation, or changes from negative to positive pressure ventilation. 4 Since increased mortality is associated with more than two direct laryngoscopy (DL) attempts among children with difficult airways, 5 the development of an easily deployable team skilled in difficult airway management could reduce patient morbidity and mortality. Previous studies have described difficult airway response team (DART) creation and implementation, [6][7][8][9][10][11] however, little attention has been paid to operating DARTs in hospitals with varying designs and operating room (OR) locations.…”

“…Unexpected difficult mask ventilation rates have been reported as 6.6% in healthy children 3 . Additionally, the emerging concept of a physiologically difficult airway involves compromising patient factors such as fluid balance and hemodynamics, medication administration including induction technique, delays in intubation, or changes from negative to positive pressure ventilation 4 …”