Thom Christopher S, Deshmukh Hitesh, Soorikian Leane, Jacobs Ian, Fiadjoe John E, Lioy Janet
Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA.
Division of Neonatology, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA.
medRxiv. 2020 Sep 27:2020.09.25.20201582. doi: 10.1101/2020.09.25.20201582.
Children's hospitals frequently care for infants with various life-threatening airway anomalies. Management of these infants can be challenging given unique airway anatomy and potential malformations. Airway emergency management must be immediate and precise, often demanding specialized equipment and/or expertise. We developed a Neonatal-Infant Airway Safety Program to improve medical responses, communication, equipment usage and outcomes for infants requiring emergent airway interventions.
All patients admitted to our quaternary neonatal and infant intensive care unit (NICU) from 2008-2019 were included in this study. Our program consisted of a multidisciplinary airway response team, pager system, and emergency equipment cart. Respiratory therapists present at each emergency event recorded specialist response times, equipment utilization, and outcomes. A multidisciplinary oversite committee reviewed each incident.
Since 2008, there were 159 airway emergency events in our NICU (~12 per year). Mean specialist response times decreased from 5.9±4.9 min (2008-2012, mean±SD) to 4.3±2.2 min (2016-2019, p=0.12), and the number of incidents with response times >5 min decreased from 28.8±17.8% (2008-2012) to 9.3±11.4% (2016-2019, p=0.04 by linear regression). As our program became more standardized, we noted better equipment availability and subspecialist communication. Few emergency situations (n=9, 6%) required operating room management. There were 3 patient deaths (2%).
Our airway safety program, including readily available specialists and equipment, facilitated effective resolution of airway emergencies in our NICU and multidisciplinary involvement enabled rapid and effective changes in response to COVID-19 regulations. A similar program could be implemented in other centers.
儿童医院经常收治患有各种危及生命的气道异常的婴儿。鉴于独特的气道解剖结构和潜在的畸形，对这些婴儿的管理可能具有挑战性。气道紧急管理必须迅速而精确，通常需要专门的设备和/或专业知识。我们制定了一项新生儿-婴儿气道安全计划，以改善对需要紧急气道干预的婴儿的医疗反应、沟通、设备使用情况及治疗结果。
本研究纳入了2008年至2019年期间入住我们四级新生儿和婴儿重症监护病房（NICU）的所有患者。我们的计划包括一个多学科气道反应团队、寻呼系统和应急设备推车。每次紧急事件到场的呼吸治疗师记录专家反应时间、设备使用情况及治疗结果。一个多学科监督委员会审查每起事件。
自2008年以来，我们的NICU发生了159起气道紧急事件（每年约12起）。专家平均反应时间从5.9±4.9分钟（2008 - 2012年，均值±标准差）降至4.3±2.2分钟（2016 - 2019年，p = 0.12），反应时间>5分钟的事件数量从28.8±17.8%（2008 - 2012年）降至9.3±11.4%（2016 - 2019年，线性回归p = 0.04）。随着我们的计划变得更加标准化，我们注意到设备可用性和专科医生之间的沟通有所改善。很少有紧急情况（n = 9，6%）需要手术室管理。有3例患者死亡（2%）。
我们的气道安全计划，包括随时可用的专家和设备，有助于在我们的NICU有效解决气道紧急情况，多学科参与使得能够根据COVID - 19规定迅速做出有效改变。类似的计划可在其他中心实施。
