Pearson Thomas E, Frizzola Meg A, Khine Henry H
Department of Nursing, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
Division of Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
Air Med J. 2019 Jan-Feb;38(1):51-54. doi: 10.1016/j.amj.2018.10.002. Epub 2018 Dec 3.
The effect of using uncuffed endotracheal tubes in children during interfacility critical care transport has not yet been assessed. We hypothesized that many children with uncuffed endotracheal tubes experience complications leading to replacement with a cuffed tube after arrival at a tertiary pediatric care facility.
We conducted a retrospective case review of all intubated patients transported by our dedicated pediatric critical care transport team to our pediatric intensive care unit over a 3-year period. The incidence of urgent reintubation was studied.
A total of 213 children were referred for transport with an endotracheal tube in place, with 55 of those with an uncuffed endotracheal tube (25.8% of all intubated patients). Of those with uncuffed tubes, 24 patients needed their tubes replaced on an urgent basis by the medical team because of issues with ineffective ventilation (43.6% of patients with uncuffed tubes or 11.3% of all intubated patients). No cuffed tubes required replacement.
Placing an uncuffed endotracheal tube in the critically ill child who is referred to tertiary pediatric care results in a significant number of these patients undergoing a repeat laryngoscopy, with all associated risks, to replace the uncuffed tube with a cuffed tube.
在院际重症监护转运期间使用无套囊气管内导管对儿童的影响尚未得到评估。我们推测，许多使用无套囊气管内导管的儿童会出现并发症，导致在抵达三级儿科护理机构后更换为有套囊导管。
我们对我们专门的儿科重症监护转运团队在3年期间转运至我们儿科重症监护病房的所有插管患者进行了回顾性病例审查。研究了紧急重新插管的发生率。
共有213名儿童在气管内导管在位的情况下被转诊进行转运，其中55名使用无套囊气管内导管（占所有插管患者的25.8%）。在使用无套囊导管的患者中，24名患者因通气无效问题被医疗团队紧急更换导管（占使用无套囊导管患者的43.6%或所有插管患者的11.3%）。没有有套囊导管需要更换。
在转诊至三级儿科护理的重症患儿中放置无套囊气管内导管会导致大量此类患者接受重复喉镜检查，并承担所有相关风险，以便用有套囊导管替换无套囊导管。
