Bigelow Amee M, Gothard M David, Schwartz Hamilton P, Bigham Michael T
Prehosp Emerg Care. 2015 Jul-Sep;19(3):351-7. doi: 10.3109/10903127.2014.980481. Epub 2015 Feb 9.
There are nearly 200,000 US infants/children transported annually for specialty care and there are no published best practices in transport intubation.
Respiratory interventions are a priority in pediatric and neonatal critical care transport (PNCCT). A recent Delphi study identified intubation performance as an important PNCCT quality metric, though data are insufficient. The objective of the study is to determine multi-center rates of first attempt intubation success in pediatric/neonatal transport and identify practice processes associated with higher performing centers.
Retrospective chart review where data was collected from the 9 participating centers over a 6-month period from January-June 2013. Data describing intubation training and practices were gathered using SurveyMonkey® (Palo Alto, CA). Data were tabulated in Microsoft Excel (Redmond, WA) and analyzed using descriptive statistics. Through the determination of 1(st) intubation success rate across multiple pediatric/neonatal critical care transport programs, we hypothesized that the features of higher and lower performing centers can be identified to inform practice.
9 of 14 invited institutions participated. The median (IQR) 6-month transport volume for neonates(neo) was 289(35-646) and pediatric (ped) 510(122-831). On average, 7%(+/-3.0) of neo and 1.6%(+/-0.7) of ped transport patients required intubation. Individual centers had their initial success rate calculated and a 95% confidence interval was determined for those centers satisfying the np > 5 and n(1-p) > 5 sample size requirement for normality assumption of proportions. Since the overall success rate was 64%, it was determined that n = 14 initial intubation attempts would be the minimum number needed per center in order to fulfill the sample size requirement for normality assumption. Centers whose 95% confidence interval did not contain the initial overall success rate were identified.
This represents the first multi-center neo/ped intubation dataset in PNCCT. First attempt intubation success lags behind reported anesthesia intubation rates but parallels pediatric emergency department intubation success rates. Training and operational processes are variable in PNCCT, though top performing teams require live-patient intubation success to achieve initial intubation competency.
美国每年有近20万名婴幼儿被转运至专科医疗机构接受治疗，目前尚无关于转运插管的最佳实践发表。
呼吸干预是儿科和新生儿重症监护转运（PNCCT）的首要任务。最近一项德尔菲研究将插管操作表现确定为一项重要的PNCCT质量指标，尽管数据尚不充分。本研究的目的是确定儿科/新生儿转运首次插管成功的多中心发生率，并找出与表现较好的中心相关的实践流程。
进行回顾性病历审查，从9个参与中心收集2013年1月至6月6个月期间的数据。使用SurveyMonkey®（加利福尼亚州帕洛阿尔托）收集描述插管培训和实践的数据。数据在Microsoft Excel（华盛顿州雷德蒙德）中制成表格，并使用描述性统计进行分析。通过确定多个儿科/新生儿重症监护转运项目的首次插管成功率，我们假设可以识别出表现较好和较差的中心的特征，为实践提供参考。
14家受邀机构中有9家参与。新生儿（neo）6个月的转运量中位数（IQR）为289（35 - 646），儿科（ped）为510（122 - 831）。平均而言，7%（±3.0）的新生儿和1.6%（±0.7）的儿科转运患者需要插管。计算了各个中心的首次成功率，并为满足比例正态性假设的np > 5和n(1 - p) > 5样本量要求的中心确定了95%置信区间。由于总体成功率为64%，因此确定每个中心至少需要14次初始插管尝试才能满足正态性假设的样本量要求。识别出95%置信区间不包含初始总体成功率的中心。
这是PNCCT中首个多中心新生儿/儿科插管数据集。首次插管成功率低于报道的麻醉插管率，但与儿科急诊科插管成功率相当。PNCCT中的培训和操作流程各不相同，不过表现最佳的团队需要在真实患者身上插管成功才能达到初始插管能力。
