Bai Wenyu, Golmirzaie Kristine, Burke Constance, Van Veen Tara, Christensen Robert, Voepel-Lewis Terri, Malviya Shobha
Department of Anesthesiology, Division of Pediatric Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
Paediatr Anaesth. 2016 Apr;26(4):384-91. doi: 10.1111/pan.12839. Epub 2016 Jan 6.
There are limited data on pediatric emergency tracheal intubation on inpatient units and in the emergency department by anesthesiologists. This retrospective cohort study was designed to describe the frequency of difficult intubation and adverse events associated with emergency tracheal intubation performed by pediatric anesthesiologists in a large children's hospital.
All emergency tracheal intubation on inpatient units and the emergency department performed by pediatric anesthesiologists over a 7-year period in children <18 years were identified by querying our perioperative clinical information system. Medical records were comprehensively reviewed to describe the emergency intubation process and outcomes.
One hundred and thirty-two intubations from 120 children (median age 3.3 years) were eligible. The majority of emergency tracheal intubations were successful with 1-2 laryngoscopy attempts, while 14 (10.6%) were difficult. Despite grade 3 view in 3/14 cases, the airway was secured after multiple direct laryngoscopy attempts. Eleven required use of an alternative airway device to secure the airway. A preexisting airway abnormality or craniofacial abnormality was present in 57% of cases with difficult intubation including half with micrognathia or retrognathia. Major intubation-related adverse events such as aspiration, occurred in 5 (3.8%) emergency tracheal intubations. Mild-to-moderate intubation-related adverse events occurred in 23 (17.4%) emergency tracheal intubations including mainstem bronchus intubation (13.6%).
A significant rate of difficult intubation and mild-to-moderate intubation-related adverse events were found in emergency tracheal intubations on inpatient units and the emergency department in children performed by a pediatric anesthesiology emergency airway team. Difficult intubation was observed frequently in children with preexisting airway and craniofacial abnormalities and often required the use of an alternative airway device to successfully secure the airway.
关于麻醉医生在住院部和急诊科对儿科患者进行紧急气管插管的数据有限。本回顾性队列研究旨在描述一家大型儿童医院中，儿科麻醉医生进行紧急气管插管时困难插管及相关不良事件的发生频率。
通过查询我们的围手术期临床信息系统，确定了7年间儿科麻醉医生在住院部和急诊科对18岁以下儿童进行的所有紧急气管插管。全面查阅病历以描述紧急插管过程及结果。
120名儿童（中位年龄3.3岁）的132次插管符合条件。大多数紧急气管插管在进行1 - 2次喉镜检查尝试后成功，而14次（10.6%）为困难插管。尽管14例中有3例喉镜视野为3级，但在多次直接喉镜检查尝试后气道得以确保。11例需要使用替代气道装置来确保气道安全。57%的困难插管病例存在既往气道异常或颅面异常，其中一半有小颌畸形或下颌后缩。主要的插管相关不良事件如误吸，发生在5次（3.8%）紧急气管插管中。轻至中度插管相关不良事件发生在23次（17.4%）紧急气管插管中，包括主支气管插管（13.6%）。
儿科麻醉科紧急气道团队在住院部和急诊科对儿童进行紧急气管插管时，发现困难插管率以及轻至中度插管相关不良事件发生率较高。在存在既往气道和颅面异常的儿童中经常观察到困难插管，且通常需要使用替代气道装置才能成功确保气道安全。
