儿科和综合急诊科儿科患者插管结果的差异。

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments.

机构信息

Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.

Department of Emergency Medicine, KK Women's and Children's Hospital, SingHealth, Singapore City, Singapore.

出版信息

Paediatr Anaesth. 2021 Jun;31(6):713-719. doi: 10.1111/pan.14185. Epub 2021 Apr 11.

DOI:10.1111/pan.14185

PMID:33774880

Abstract

BACKGROUND

Intubation is a life-saving intervention at the Emergency Department (ED). However, general and pediatric EDs may vary in their preparedness to manage children with airway emergencies.

AIMS

We aimed to compare rates of first-pass intubation and adverse tracheal intubation-associated events between general and pediatric EDs.

METHODS

A retrospective review of medical records was conducted at a pediatric ED and three general EDs from January 1, 2015, to December 31, 2018. Information about the intubation process involving pediatric patients (less than 16 years old), as well as eventual outcomes of first-pass intubation and adverse tracheal intubation-associated events were collected and analyzed.

RESULTS

There were 180 pediatric intubations, of which 115 (63.9%) were performed in pediatric ED. The median age was 2 years old (interquartile range 0-6). Intubation was most commonly performed for patients with cardiac arrest (88, 48.9%). Direct laryngoscopy was used in 178 (98.9%) cases and uncuffed tube was used in 135 (75.0%) cases. Apneic oxygenation was performed in 26 (14.4%) cases-all in pediatric ED. Intubation was predominantly performed by senior clinicians (162, 90.0%). Overall, intubation was performed successfully in 175 (97.2%) cases, with a first-pass intubation rate of 82.2% which was similar between pediatric (96, 83.5%) and general EDs (52, 80%) (Odds ratio [OR] 1.26, 95% confidence interval [CI] 0.58 to 2.76, p = .558). There were 68 adverse tracheal intubation-associated events with right mainstem intubation being the most common (23, 12.8%). Pediatric EDs (44, 38.3%) had a higher rate of adverse tracheal intubation-associated events than general EDs (15, 23.1%) (OR 2.07, 95% CI 1.04 to 4.11; p = .037).

CONCLUSIONS

Differences exist in intubation outcomes between pediatric and general EDs. Quality improvement efforts should focus on standardizing intubation practices across both pediatric and general EDs.

摘要

背景

在急诊科（ED），插管是一项挽救生命的干预措施。然而，普通和儿科 ED 在处理气道急症患儿的准备情况上可能存在差异。

目的

我们旨在比较普通 ED 和儿科 ED 中首次插管成功率和不良气管插管相关事件的发生率。

方法

对 2015 年 1 月 1 日至 2018 年 12 月 31 日期间，一家儿科 ED 和三家普通 ED 的儿科患者（年龄小于 16 岁）的医疗记录进行回顾性分析。收集并分析首次插管成功率和不良气管插管相关事件的相关信息。

结果

共有 180 例儿科插管，其中 115 例（63.9%）在儿科 ED 进行。中位年龄为 2 岁（四分位距 0-6 岁）。插管最常用于心脏骤停患者（88 例，48.9%）。178 例（98.9%）采用直接喉镜，135 例（75.0%）采用无囊气管插管。26 例（14.4%）进行了无通气氧合，均在儿科 ED 进行。插管主要由资深临床医生进行（162 例，90.0%）。总体而言，175 例（97.2%）插管成功，首次插管成功率为 82.2%，儿科 ED（96 例，83.5%）和普通 ED（52 例，80%）相似（优势比[OR] 1.26，95%置信区间[CI] 0.58 至 2.76，p=0.558）。共有 68 例不良气管插管相关事件，其中右主支气管插管最常见（23 例，12.8%）。儿科 ED（44 例，38.3%）的不良气管插管相关事件发生率高于普通 ED（15 例，23.1%）（OR 2.07，95%CI 1.04 至 4.11；p=0.037）。