Pediatrics, Hurley Medical Center and Michigan State University, Flint, Michigan.
Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.
Respir Care. 2021 Dec;66(12):1866-1875. doi: 10.4187/respcare.09250. Epub 2021 Oct 20.
In general emergency departments, advanced airway management of pediatric patients who are critically ill has been associated with increased adverse events given the varying exposure to pediatric patients and limited resources. Previous studies have shown significant improvement of simulated pediatric airway management in general emergency departments. The aim of this retrospective study was to determine the effect of an in situ simulation-based collaborative intervention program on the actual care of pediatric airway management in general emergency departments.
This was a retrospective study of pediatric subjects who were critically ill and required intubation at a diverse set of general emergency departments before referral to the academic medical center. The primary outcome was the quality of clinical care measured by adherence to best practices via a critical action checklist. Secondary outcomes included tracheal intubation associated adverse events and clinical outcomes.
A total of 135 pediatric subjects (48 pre- and 87 post-intervention) who were transferred to the academic medical center from 9 general emergency departments between May 2014 and August 2019 were included in the analysis. The use of a cuffed endotracheal tube improved, from 44% to 72% ( = .001), whereas there was no significant change in the appropriate endotracheal tube size. Overall, severe tracheal intubation associated adverse events decreased, from 18.8% to 9.2% ( = .03), and post-intubation cardiac arrest events decreased, from 6.3% to 0% ( = .02).
A simulation-based collaborative intervention program led to improvement in pediatric airway management and subject outcomes in general emergency departments. This model demonstrated the transfer of improvement from a simulated setting to a clinical setting and may be targeted in other clinical settings.
在一般急诊科，由于儿科患者的接触情况不同且资源有限，对危重症儿科患者进行高级气道管理与不良事件的增加有关。先前的研究表明，在一般急诊科中，模拟儿科气道管理有显著改善。本回顾性研究旨在确定基于现场模拟的协作干预方案对一般急诊科儿科气道管理实际护理的影响。
这是一项回顾性研究，研究对象为在转至学术医疗中心之前在不同的一般急诊科就诊且需要进行插管的危重症儿科患者。主要结局是通过关键行动检查表衡量的临床护理质量，即最佳实践的依从性。次要结局包括与气管插管相关的不良事件和临床结局。
共纳入 135 例儿科患者（9 家一般急诊科于 2014 年 5 月至 2019 年 8 月期间转至学术医疗中心的 48 例和 87 例）。使用带套囊的气管内导管的比例从 44%提高到 72%（ =.001），而合适的气管内导管大小则没有显著变化。总的来说，严重的与气管插管相关的不良事件发生率从 18.8%下降到 9.2%（ =.03），插管后心脏骤停事件从 6.3%下降到 0%（ =.02）。
基于模拟的协作干预方案可改善一般急诊科的儿科气道管理和患者结局。这种模式证明了从模拟环境到临床环境的改进的转移，可能针对其他临床环境。
