Simma Leopold, Cincotta Domenic, Sabato Stefan, Long Elliot
Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.
Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Arch Dis Child. 2017 Sep;102(9):809-812. doi: 10.1136/archdischild-2016-311945. Epub 2017 Apr 12.
Airway emergencies presenting to the emergency department (ED) are usually managed with conventional equipment and techniques. The patient group managed urgently in the operating room (OR) has not been described.
This study aims to describe a case series of children presenting to the ED with airway emergencies managed urgently in the OR, particularly the anaesthetic equipment and techniques used and airway findings.
A retrospective cohort study undertaken at The Royal Children's Hospital, Melbourne, Australia. All patients presenting to the ED between 1 January 2012 and 30 July 2015 (42 months) with an airway emergency who were subsequently managed in the OR were included. Patient characteristics, anaesthetic equipment and technique and airway findings were recorded.
Twenty-two airway emergencies in 21 patients were included over the study period, on average one every 2 months. Median age was 18 months and 43% were male. Inhalational induction was used in 77.3%, combined inhalational and intravenous induction in 9.1%, and intravenous induction alone in 13.6%. The most commonly used inhalational induction agent was sevoflurane, and the most commonly used intravenous induction agents were ketamine and propofol. Ten airway emergencies did not require intubation, seven for removal of inhaled foreign body, two with progressive tracheal stenosis requiring emergent dilatation and one examination under anaesthesia to rule out inhaled foreign body. Of the 12 airway emergencies that required immediate intubation, direct laryngoscopy was used in 9 and fibre-optic intubating bronchoscopy in 3. For intubations performed by direct laryngoscopy, one was difficult (Cormack and Lehane grade 3). First pass success was 83.3%. Adverse events occurred in 3/22 (13.6%) cases.
Advanced airway techniques, including inhalational induction and intubation via fibre-optic intubating bronchoscope, are rarely but predictably required in the management of patients presenting to the ED. Institutions caring for children should prepare in advance where such patients should be managed, by whom, and provide equipment and training for their care.
急诊科处理的气道急症通常采用传统设备和技术进行管理。尚未对在手术室（OR）进行紧急处理的患者群体进行描述。
本研究旨在描述一系列在急诊科出现气道急症并在手术室进行紧急处理的儿童病例，特别是所使用的麻醉设备和技术以及气道检查结果。
在澳大利亚墨尔本皇家儿童医院进行的一项回顾性队列研究。纳入2012年1月1日至2015年7月30日（42个月）期间在急诊科出现气道急症并随后在手术室进行处理的所有患者。记录患者特征、麻醉设备和技术以及气道检查结果。
在研究期间纳入了21例患者的22起气道急症，平均每2个月1例。中位年龄为18个月，43%为男性。77.3%采用吸入诱导，9.1%采用吸入与静脉联合诱导，13.6%仅采用静脉诱导。最常用的吸入诱导剂是七氟醚，最常用的静脉诱导剂是氯胺酮和丙泊酚。10起气道急症无需插管，7起用于取出吸入性异物，2起因进行性气管狭窄需要紧急扩张，1起在麻醉下检查以排除吸入性异物。在12起需要立即插管的气道急症中，9起采用直接喉镜检查，3起采用纤维支气管镜插管。对于通过直接喉镜检查进行的插管，1例困难（Cormack和Lehane 3级）。首次插管成功率为83.3%。3/22（13.6%）例发生不良事件。
在急诊科处理患者时，很少但可预测地需要先进的气道技术。包括吸入诱导和通过纤维支气管镜插管，照顾儿童的机构应提前做好准备，确定此类患者应由谁在何处进行处理，并提供护理所需的设备和培训。
