Boswell W C, McElveen N, Sharp M, Boyd C R, Frantz E I
Memorial Medical Center, Savannah, GA 31403, USA.
Air Med J. 1995 Jul-Sep;14(3):125-7; discussion 127-8. doi: 10.1016/1067-991x(95)90513-8.
Pediatric airway control, including endotracheal intubation (ETI), presents a clinical challenge in the prehospital setting. Endotracheal intubation is recommended for serious head injury (Glasgow Coma Scale score <=8). We evaluated the frequency of ETI in pediatric and adult patients with <=8 in the field, subsequently transported by a hospital-based, helicopter emergency medical service (HHEMS).
A retrospective, descriptive study of pediatric patients (<=14 years) and adult patients with GCS <=8 transported by HHEMS from January 1988 through March 1994 was conducted. Significance was determined by chi-square analysis.
Inclusion criteria were met by 63 (15%) pediatric patients and 353 (85%) adults. Of the pediatric patients, 38 (60%) were intubated endotracheally; mean age was 7; mean injury severity score (ISS) was 28. Of adults, 267 (76%) were intubated endotracheally; mean age was 35; mean ISS was 33. A 16-percentage-point difference in frequency of successful ETI between groups was found to be significant (p <=0.01). Of 25 nonintubated pediatric (PED) patients, unsuccessful attempts were made on 20 (80%); 14 of 25 (56%) had significant head injuries evident on computerized tomography (CT) scan. Of 86 nonintubated adults, unsuccessful attempts were made on 29 (34%); 61 (71%) had significant head injuries.
Pediatric coma patients were not intubated with the same frequency as adults. This discrepancy between groups was secondary to a higher failure rate in the pediatric group. Intubation was attempted in 92% of pediatric patients versus 84% of the adults. Unsuccessful intubation attempts in the pediatric group, 20 of 58 (34%), were compared with 29 of 296 (9.8%) in the adult group. Difficulty in pediatric airway control may require an increased level of training and experience.
小儿气道控制，包括气管插管（ETI），在院前环境中是一项临床挑战。对于严重颅脑损伤（格拉斯哥昏迷量表评分≤8）患者，建议进行气管插管。我们评估了在现场格拉斯哥昏迷量表评分≤8的小儿和成年患者中气管插管的频率，这些患者随后由一家基于医院的直升机紧急医疗服务（HHEMS）转运。
对1988年1月至1994年3月期间由HHEMS转运的格拉斯哥昏迷量表评分≤8的小儿患者（≤14岁）和成年患者进行了一项回顾性描述性研究。通过卡方分析确定显著性。
63名（15%）小儿患者和353名（85%）成年患者符合纳入标准。小儿患者中，38名（60%）进行了气管插管；平均年龄为7岁；平均损伤严重程度评分（ISS）为28分。成年患者中，267名（76%）进行了气管插管；平均年龄为35岁；平均ISS为33分。两组间成功气管插管频率的16个百分点差异具有显著性（p≤0.01）。在25名未插管的小儿患者中，20名（80%）插管尝试失败；25名中有14名（56%）在计算机断层扫描（CT）上显示有明显的严重颅脑损伤。在86名未插管的成年患者中，29名（34%）插管尝试失败；61名（71%）有明显的严重颅脑损伤。
小儿昏迷患者的气管插管频率与成年患者不同。两组间的这种差异是由于小儿组的失败率较高。92%的小儿患者尝试了插管，而成年患者为84%。小儿组插管尝试失败的有58例中的20例（34%），而成年组为296例中的29例（9.8%）。小儿气道控制的困难可能需要更高水平的培训和经验。
