Emergency Department, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Paediatric Emergency Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Eur J Emerg Med. 2018 Jun;25(3):209-215. doi: 10.1097/MEJ.0000000000000439.
Rapid sequence intubation and emergency intubation in the emergency department (ED) can be life-saving procedures, but require the appropriate skills, experience and preparation to avoid complications ranging from simple trauma to life-threatening desaturation. Only scarce data exist in the published literature on complications following emergency intubation in children and most guidelines are extrapolated from the adult population.
We reviewed all emergency intubations of patients in our tertiary paediatric ED within a 2-year period to estimate the incidence of complications and to analyse the risk factors associated with this procedure.
Seventy-two children were intubated; complications occurred in one in four and repeated attempts at intubation in 17/23 children. The median age of the children was 2 years (range: 0 days-6 years). The most common reason for intubation was altered level of consciousness and the most frequent diagnosis at the time of intubation was seizure/status epilepticus. Complications were related to desaturation (n=7), equipment failure (n=3), intravenous access (n=2) and hypotension (n=2), erroneous or insufficient drug preparation (n=1) and other reasons (n=3). There was no significant association of complications with the child's age or weight, time of arrival to ED, preintubation hypotension or combination of drugs used.
Complications of rapid sequence intubation, a relatively low-frequency procedure in the paediatric ED, occurred in one of four children and repeat attempts at intubation were made in another 24%. We suggest that the use of an intubation checklist including the preparation of equipment and recommendations for drug use would minimize the occurrence of adverse events of intubation in children.
在急诊科（ED）进行快速序贯插管和紧急插管是救命的程序，但需要适当的技能、经验和准备，以避免从简单的创伤到危及生命的低氧血症等并发症。发表的文献中仅有少量数据涉及儿童紧急插管后的并发症，大多数指南都是从成人人群中推断出来的。
我们回顾了我们的三级儿科 ED 中所有在 2 年内进行紧急插管的患者，以估计并发症的发生率，并分析与该程序相关的危险因素。
72 名儿童进行了插管；四分之一的儿童出现并发症，23 名儿童中有 17 名重复插管尝试。儿童的中位年龄为 2 岁（范围：0 天至 6 岁）。插管的最常见原因是意识水平改变，插管时最常见的诊断是癫痫/癫痫持续状态。并发症与低氧血症（n=7）、设备故障（n=3）、静脉通路（n=2）和低血压（n=2）、药物配制错误或不足（n=1）和其他原因（n=3）有关。并发症与儿童的年龄或体重、到达 ED 的时间、插管前低血压或使用的药物组合之间没有显著关联。
在儿科 ED 中，快速序贯插管是一种相对低频的程序，但在四分之一的儿童中发生了并发症，另外 24%的儿童需要重复插管尝试。我们建议使用包括设备准备和药物使用建议在内的插管检查表，以最大限度地减少儿童插管不良事件的发生。
