Endotracheal intubation in the pediatric emergency department

Long, Elliot; Sabato, Stefan; Babl, Franz E

doi:10.1111/pan.12490

Cited by 80 publications

(102 citation statements)

References 31 publications

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“…The fact that our data is statistically similar to previous studies from other developed and developing countries, which also found low volumes of encounters with critical illness requiring resuscitation interventions in the PED, shows that our experience in a tertiary care PED is not unique. 11,12 In this study, the majority of cohort were 1 to 5 years of age. Other studies, however, have showed most of the children are being younger than 1 year.…”

Section: Discussionmentioning

confidence: 86%

“…This is consistent with previously published data which demonstrated the mean range of ETIs per 1,000 PED patients to be 0.8 to 3.3. 5,10,11 This study is first to report the scope of ETI practice among PEDs in Turkey. The fact that our data is statistically similar to previous studies from other developed and developing countries, which also found low volumes of encounters with critical illness requiring resuscitation interventions in the PED, shows that our experience in a tertiary care PED is not unique.…”

Section: Discussionmentioning

confidence: 99%

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Frequency and outcomes of endotracheal intubation in the pediatric emergency department

et al. 2017

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Intubation is a core airway skill in Pediatric Emergency Medicine (PEM). The data on pediatric endotracheal intubation in the emergency department, especially in developing countries, is currently very limited. This study was designed to describe the frequency, clinical features and outcomes of pediatric intubation in a large children's hospital.We performed a retrospective analysis of PEM medical records between January 2014 and December 2015 that involved any attempted intubations of children younger than 18 years. The medical records were reviewed to describe the intubation process, demographics, clinical features and outcomes.A total of 110,000 patients visited our emergency department during the study period. Ninety-one of them (1/1300) were intubated. The median age was 2 years, (F/M: 1) and 25 patients were younger than 12 months. Respiratory failure was the most common indication for intubation (42%), followed by status epilepticus (26%) and sepsis-shock (16%). Mortality was associated with prolonged chest compression (more than 10 minute). A poor outcome was associated with sepsis-shock and cardiac diseases; however, better outcomes were associated with status epilepticus (p<0.001). The first attempt success (FAS) was achieved in 60/91 (66 %) patients and the FAS rate was also higher in younger patients (p=0.002). The discharge rate of all intubated patients in our study was sixty-four percent.Pediatric residents performed the majority of intubations. A higher FAS rate was associated with younger patients. Favorable outcomes were directly related to duration of cardiopulmonary resuscitation and main diagnosis.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Frequency and outcomes of endotracheal intubation in the pediatric emergency department

et al. 2017

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“…Intubation is an uncommon procedure in the paediatric ED 13. Airway emergencies that require advanced management in the OR are even less common.…”

Section: Discussionmentioning

confidence: 99%

“…First pass success has been reported as 40%–80%, with a 15%–40% incidence of profound desaturation, 5%–21% incidence of severe hypotension and 1%–2% incidence of cardiac arrest 2–11. Unstable physiology, the ‘physiologically difficult airway’,12 contributes more to the high rate of adverse events than anatomically difficult airways (Cormack and Lehane (C&L) grade 3 or 4 on direct laryngoscopy) 13. In a 7-year retrospective audit of anaesthetic involvement in non-OR airway emergencies, Bai et al encountered difficult airways (C&L grade 3) in 3/120 (2%) of cases 14.…”

Section: Introductionmentioning

confidence: 99%

“…Successful intubation was performed using flexible fibre-optic scope in 3/120 (2%) and video-assisted laryngoscopy (C-Mac or glidescope) in 4/120 (3%). During a 1-year prospective audit of all intubations performed in our paediatric emergency department (ED), no difficult airways were encountered13 (as defined by the American Society of Anesthesiologists (ASA): it is not possible to visualise any portion of the vocal cords after multiple attempts at conventional laryngoscopy) 15. Two of 71 intubations (3%) had C&L grade 3 airways, which improved to C&L grade 2 with change in operator, position or with the use of external laryngeal manipulation.…”

Section: Introductionmentioning

confidence: 99%

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Airway emergencies presenting to the paediatric emergency department requiring advanced management techniques

Simma

Cincotta²,

Sabato

et al. 2017

Arch Dis Child

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Advancing emergency airway management practice and research

Goto

Hagiwara

et al. 2019

Acute Medicine & Surgery

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Emergency airway management is one of the vital resuscitative procedures undertaken in the emergency department (ED). Despite its clinical and research importance in the care of critically ill and injured patients, earlier studies have documented suboptimal intubation performance and high adverse event rates with a wide variation across the EDs. The optimal emergency airway management strategies remain to be established and their dissemination to the entire nation is a challenging task. This article reviews the current published works on emergency airway management with a focus on the use of airway management algorithms as well as the importance of first‐pass success and systematic use of rescue intubation strategies. Additionally, the review summarizes the current evidence for each of the important airway management processes, such as assessment of the difficult airway, preparation (e.g., positioning and oxygenation), intubation methods (e.g., rapid sequence intubation), medications (e.g., premedications, sedatives, and neuromuscular blockades), devices (e.g., direct and video laryngoscopy and supraglottic devises), and rescue intubation strategies (e.g., airway adjuncts and rescue intubators), as well as the airway management in distinct patient populations (i.e., trauma, cardiac arrest, and pediatric patients). Well‐designed, rigorously conducted, multicenter studies that prospectively and comprehensively characterize emergency airway management should provide clinicians with important opportunities for improving the quality and safety of airway management practice. Such data will not only advance research into the determination of optimal airway management strategies but also facilitate the development of clinical guidelines, which will, in turn, improve the outcomes of critically ill and injured patients in the ED.

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Endotracheal intubation in the pediatric emergency department

Cited by 80 publications

References 31 publications

Frequency and outcomes of endotracheal intubation in the pediatric emergency department

Frequency and outcomes of endotracheal intubation in the pediatric emergency department

Airway emergencies presenting to the paediatric emergency department requiring advanced management techniques

Advancing emergency airway management practice and research

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