aDepartment of Anaesthesia, Pain and Critical Care, Western General Hospital bDepartment of Emergency Medicine, Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK.
Eur J Emerg Med. 2017 Dec;24(6):e6-e10. doi: 10.1097/MEJ.0000000000000398.
Tracheal intubation is the cornerstone of advanced emergency airway management in children and adults and there is good-quality data characterizing intubation in both groups. There are, however, few published studies on emergency tracheal intubation in adolescents. We carried out an observational study to characterize tracheal intubation in adolescents.
We analysed data from a previously collected Emergency Department Intubation Registry. We included all attempts at tracheal intubation performed in our adult emergency department between 1999 and 2011. We recorded the indication for intubation, the staff involved, the technique and drugs used, and the rates of successful intubation and adverse events. We classified patients into three age groups: 13-16 years (adolescent), 17-24 years (young adult) and at least 25 years (older adult).
Trauma was the most common indication for intubation in adolescents, and rapid sequence induction was used in 88% of cases. Ninety-nine percent of tracheal intubations in adolescent patients were successful on the first or the second attempt, no adolescent underwent more than three attempts and none required a surgical airway. The initial intubation attempt in adolescents was more likely to be performed by an anaesthetist (P<0.005). The first attempt success rate was higher (P<0.01) and adverse event rate was lower (P<0.05) in adolescents than in adults. Hypotension was the only adverse event recorded in adolescents; this occurred in three patients (4.5%).
Our findings suggest that the airway in adolescent patients can be managed successfully and safely in an adult emergency department where there is close collaboration between anaesthetists and emergency physicians.
气管插管是儿童和成人高级急救气道管理的基石，有大量高质量数据可用于描述这两个群体的插管情况。然而，关于青少年急救气管插管的研究很少。我们进行了一项观察性研究，以描述青少年的气管插管情况。
我们分析了之前收集的急诊科插管登记处的数据。我们纳入了 1999 年至 2011 年期间在我们成人急诊科进行的所有气管插管尝试。我们记录了插管的指征、参与人员、使用的技术和药物，以及插管成功率和不良事件发生率。我们将患者分为三组：13-16 岁（青少年）、17-24 岁（青年）和至少 25 岁（成人）。
创伤是青少年插管最常见的指征，88%的病例采用快速序列诱导。99%的青少年患者在第一次或第二次尝试中成功插管，没有患者需要进行超过三次尝试，也没有患者需要进行手术气道。青少年的初始插管尝试更可能由麻醉师进行（P<0.005）。青少年的首次尝试成功率更高（P<0.01），不良事件发生率更低（P<0.05）。青少年唯一记录的不良事件是低血压，发生在 3 名患者（4.5%）中。
我们的研究结果表明，在有麻醉师和急诊医师密切合作的成人急诊科，可以成功、安全地管理青少年患者的气道。
