Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Pediatric Emergency Care Applied Research Network (PECARN), USA.
Yale University School of Medicine, New Haven, CT, USA; Pediatric Emergency Medicine Collaborative Research Committee (PEM-CRC), USA.
Am J Emerg Med. 2021 Apr;42:70-77. doi: 10.1016/j.ajem.2020.12.075. Epub 2020 Dec 31.
Airway management procedures are critical for emergency medicine (EM) physicians, but rarely performed skills in pediatric patients. Worldwide experience with respect to frequency and confidence in performing airway management skills has not been previously described.
Our aims were 1) to determine the frequency with which emergency medicine physicians perform airway procedures including: bag-mask ventilation (BMV), endotracheal intubation (ETI), laryngeal mask airway (LMA) insertion, tracheostomy tube change (TTC), and surgical airways, and 2) to investigate predictors of procedural confidence regarding advanced airway management in children.
A web-based survey of senior emergency physicians was distributed through the six research networks associated with Pediatric Emergency Research Network (PERN). Senior physician was defined as anyone working without direct supervision at any point in a 24-h cycle. Physicians were queried regarding their most recent clinical experience performing or supervising airway procedures, as well as with hands on practice time or procedural teaching. Reponses were dichotomized to within the last year, or ≥ 1 year. Confidence was assessed using a Likert scale for each procedure, with results for ETI and LMA stratified by age. Response levels were dichotomized to "not confident" or "confident." Multivariate regression models were used to assess relevant associations.
1602 of 2446 (65%) eligible clinicians at 96 PERN sites responded. In the previous year, 1297 (85%) physicians reported having performed bag-mask ventilation, 900 (59%) had performed intubation, 248 (17%) had placed a laryngeal mask airway, 348 (23%) had changed a tracheostomy tube, and 18 (1%) had performed a surgical airway. Of respondents, 13% of physicians reported the opportunity to supervise but not provide ETI, 5% for LMA and 5% for BMV. The percentage of physicians reporting "confidence" in performing each procedure was: BMV (95%) TTC (43%), and surgical airway (16%). Clinician confidence in ETT and LMA varied by patient age. Supervision of an airway procedure was the strongest predictor of procedural confidence across airway procedures.
BMV and ETI were the most commonly performed pediatric airway procedures by emergency medicine physicians, and surgical airways are very infrequent. Supervising airway procedures may serve to maintain procedural confidence for physicians despite infrequent opportunities as the primary proceduralist.
气道管理程序对于急诊医学（EM）医师至关重要，但在儿科患者中很少进行这些技能操作。以前没有描述过全球范围内进行气道管理技能的频率和信心。
我们的目的是 1）确定急诊医师进行气道程序的频率，包括：袋面罩通气（BMV）、气管内插管（ETI）、喉罩气道（LMA）插入、气管造口管更换（TTC）和外科气道，以及 2）调查有关儿童高级气道管理程序信心的预测因素。
通过与儿科急诊研究网络（PERN）相关的六个研究网络，向高级急诊医师分发了基于网络的调查。高级医师定义为在 24 小时周期内任何时候都无需直接监督即可工作的任何人。医师被询问他们最近进行或监督气道程序的临床经验，以及进行实际操作的时间或程序教学。答复分为在过去一年中或≥1 年内。使用李克特量表评估每种程序的信心程度，ETI 和 LMA 的结果按年龄分层。响应水平分为“不自信”或“自信”。使用多元回归模型评估相关关联。
在 96 个 PERN 站点的 2446 名符合条件的临床医生中，有 1602 名（65%）做出了回应。在过去的一年中，有 1297 名（85%）医师报告进行了袋面罩通气，900 名（59%）进行了插管，248 名（17%）放置了喉罩气道，348 名（23%）更换了气管造口管，18 名（1%）进行了手术气道。在回答者中，有 13%的医师报告有机会监督但不提供 ETI，5%的医师报告有机会提供 LMA，5%的医师报告有机会提供 BMV。报告“有信心”进行每项程序的医师百分比为：BMV（95%）、TTC（43%）和手术气道（16%）。医师对 ETT 和 LMA 的信心因患者年龄而异。气道程序的监督是气道程序中最有力的预测因素。
BMV 和 ETI 是急诊医师最常进行的儿科气道程序，而手术气道非常少见。尽管作为主要程序医师的机会很少，但监督气道程序可能有助于维持医师的程序信心。
