Dalesio Nicholas M, Burgunder Lauren, Diaz-Rodriguez Natalia M, Jones Sara I, Duval-Arnould Jordan, Lester Laeben C, Tunkel David E, Kudchadkar Sapna R
Otolaryngology/Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
Anesthesiology and Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA.
Cureus. 2021 Jul 2;13(7):e16118. doi: 10.7759/cureus.16118. eCollection 2021 Jul.
Background The goal of this study was to determine if difficult airway risk factors were similar in children cared for by the difficult airway response team (DART) and those cared for by the rapid response team (RRT). Methods In this retrospective database analysis of prospectively collected data, we analyzed patient demographics, comorbidities, history of difficult intubation, and intubation event details, including time and place of the emergency and devices used to successfully secure the airway. Results Within the 110-patient cohort, median age (IQR) was higher among DART patients than among RRT patients [8.5 years (0.9-14.6) versus 0.3 years (0.04-3.6); P< 0.001]. The odds of DART management were higher for children ages 1-2 years (aOR, 43.3; 95% CI: 2.73-684.3) and >5 years (aOR, 13.1; 95% CI: 1.85-93.4) than for those less than one-year-old. DART patients were more likely to have craniofacial abnormalities (aOR, 51.6; 95% CI: 2.50-1065.1), airway swelling (aOR, 240.1; 95% CI: 13.6-4237.2), or trauma (all DART managed). Among patients intubated by the DART, children with a history of difficult airway were more likely to have musculoskeletal (P= 0.04) and craniofacial abnormalities (P < 0.001), whereas children without a known history of difficult airway were more likely to have airway swelling (P = 0.04). Conclusion Specific clinical risk factors predict the need for emergency airway management by the DART in the pediatric hospital setting. The coordinated use of a DART to respond to difficult airway emergencies may limit attempts at endotracheal tube placement and mitigate morbidity.
背景 本研究的目的是确定在由困难气道反应小组（DART）护理的儿童和由快速反应小组（RRT）护理的儿童中，困难气道危险因素是否相似。方法 在这项对前瞻性收集数据的回顾性数据库分析中，我们分析了患者的人口统计学特征、合并症、困难插管史以及插管事件细节，包括急诊的时间和地点以及成功确保气道安全所使用的设备。结果 在110例患者队列中，DART组患者的年龄中位数（IQR）高于RRT组患者[8.5岁（0.9 - 14.6）对0.3岁（0.04 - 3.6）；P < 0.001]。1 - 2岁儿童（aOR，43.3；95% CI：2.73 - 684.3）和大于5岁儿童（aOR，13.1；95% CI：1.85 - 93.4）接受DART管理的几率高于1岁以下儿童。DART组患者更有可能出现颅面畸形（aOR，51.6；95% CI：2.50 - 1065.1）、气道肿胀（aOR，240.1；95% CI：13.6 - 4237.2）或创伤（均由DART管理）。在由DART插管的患者中，有困难气道病史的儿童更有可能出现肌肉骨骼异常（P = 0.04）和颅面畸形（P < 0.001），而无已知困难气道病史的儿童更有可能出现气道肿胀（P = 0.04）。结论 特定的临床危险因素可预测儿科医院环境中DART进行紧急气道管理的必要性。协调使用DART应对困难气道紧急情况可能会减少气管插管尝试次数并降低发病率。
