Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK.
Anaesthesia. 2018 Nov;73(11):1337-1344. doi: 10.1111/anae.14359. Epub 2018 Aug 15.
In 2011, the Fourth National Audit Project (NAP4) reported high rates of airway complications in adult intensive care units (ICUs), including death or brain injury, and recommended preparation for airway difficulty, immediately available difficult airway equipment and routine use of waveform capnography monitoring. More than 80% of UK adult intensive care units have subsequently changed practice. Undetected oesophageal intubation has recently been listed as a 'Never Event' in UK practice, with capnography mandated. We investigated whether the NAP4 recommendations have been embedded into paediatric and neonatal intensive care practice by conducting a telephone survey of senior medical or nursing staff in UK paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs). Response rates were 100% for paediatric intensive care units and 90% for neonatal intensive care units. A difficult airway policy existed in 67% of paediatric intensive care units and in 40% of neonatal intensive care units; a pre-intubation checklist was used in 70% of paediatric intensive care units and in 42% of neonatal intensive care units; a difficult intubation trolley was present in 96% of paediatric intensive care units and in 50% of neonatal intensive care units; a videolaryngoscope was available in 55% of paediatric intensive care units and in 29% of neonatal intensive care units; capnography was 'available' in 100% of paediatric intensive care units and in 46% of neonatal intensive care units, and 'always available' in 100% of paediatric intensive care units and in 18% of neonatal intensive care units. Death or serious harm occurring secondary to complications of airway management in the last 5 years was reported in 19% of paediatric intensive care units and in 26% of neonatal intensive care units. We conclude that major gaps in optimal airway management provision exist in UK paediatric intensive care units and especially in UK neonatal intensive care units. Wider implementation of waveform capnography is necessary to ensure compliance with the new 'Never Event' and has the potential to improve airway management.
2011 年，第四次全国审计项目（NAP4）报告称，成人重症监护病房（ICU）的气道并发症发生率很高，包括死亡或脑损伤，并建议为气道困难做好准备，立即提供困难气道设备，并常规使用波形二氧化碳监测。此后，超过 80%的英国成人重症监护病房改变了做法。最近，在英国实践中，未检测到的食管插管被列为“绝不应该发生的事件”，强制使用二氧化碳监测。我们通过对英国儿科重症监护病房（PICU）和新生儿重症监护病房（NICU）的高级医护人员进行电话调查，调查 NAP4 建议是否已纳入儿科和新生儿重症监护实践。儿科重症监护病房的回应率为 100%，新生儿重症监护病房的回应率为 90%。67%的儿科重症监护病房有困难气道政策，40%的新生儿重症监护病房有困难气道政策；70%的儿科重症监护病房使用插管前检查表，42%的新生儿重症监护病房使用插管前检查表；96%的儿科重症监护病房有困难插管车，50%的新生儿重症监护病房有困难插管车；55%的儿科重症监护病房有可视喉镜，29%的新生儿重症监护病房有可视喉镜；100%的儿科重症监护病房可以使用二氧化碳监测，46%的新生儿重症监护病房可以使用二氧化碳监测，100%的儿科重症监护病房始终可以使用二氧化碳监测，18%的新生儿重症监护病房始终可以使用二氧化碳监测。在过去 5 年中，有 19%的儿科重症监护病房和 26%的新生儿重症监护病房报告称，因气道管理并发症导致死亡或严重伤害。我们的结论是，英国儿科重症监护病房，尤其是英国新生儿重症监护病房，在提供最佳气道管理方面存在重大差距。更广泛地实施波形二氧化碳监测是必要的，以确保符合新的“绝不应该发生的事件”，并有可能改善气道管理。
