Nonoyama Mika L, Kukreti Vinay, Papaconstantinou Efrosini, Kozlowski Natascha, Tsimelkas Sarah
Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.
Department of Respiratory Therapy & Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada.
Can J Respir Ther. 2022 Jun 10;58:69-76. doi: 10.29390/cjrt-2022-015. eCollection 2022.
Emergency intubation is a high-risk procedure in children. Studies describing intubation practices in locations other than pediatric centres are scarce and varied. This study described pediatric intubations in adult-based community emergency departments (EDs) and determined what factors were associated with intubated-related adverse events (AEs) and described outcomes of children transferred to a quaternary care pediatric institution.
This is a retrospective review of data collected between January 2006 and March 2017 at Lakeridge Health and Hospital for Sick Children (SickKids). Patients were <18 years and intubated in Lakeridge Health EDs; those intubated prior to ED arrival were excluded. Primary outcomes were intubation first-pass success (FPS) and AEs secondary to intubation.
Patients ( = 121) were analyzed, and median (interquartile range (IQR)) age was 3.7 (0.4-14.3) years. There were 76 (62.8%) FPS, with no difference between pediatricians ( = 25, 23%) or anaesthetists ( 12, 11%), versus all other providers (paramedic 13 (12%), ED physician 37 (34%), respiratory therapist 20 (18%), transfer team 2 (2%)). The proportion of AEs was 24 (19.8%, 21 minor, 3 major), with no significant difference between pediatricians or anaesthetists versus all other providers. Data from 68 children transferred to SickKids were available, with the majority extubated within a short median (IQR) time of admission, 1.2 (0.29-3.8) days.
Pediatric intubations were rare in a Canadian adult-based community hospital system. Most intubations demonstrated FPS with relatively few AEs and no significant differences between health provider type. Future investigations should utilize multi-centred data to inform strategies suited for organizations' unique practice cultures, including training programs.
紧急气管插管在儿童中是一项高风险操作。描述儿科中心以外地点插管操作的研究稀缺且各不相同。本研究描述了在以成人为主的社区急诊科（ED）进行的儿科气管插管情况，确定了与插管相关不良事件（AE）相关的因素，并描述了转至四级护理儿科机构的儿童的结局。
这是一项对2006年1月至2017年3月在莱克里奇健康中心和病童医院（SickKids）收集的数据进行的回顾性分析。患者年龄<18岁，在莱克里奇健康中心急诊科进行气管插管；排除在到达急诊科之前已插管的患者。主要结局是插管首次通过成功率（FPS）和插管继发的AE。
对121例患者进行了分析，中位（四分位间距（IQR））年龄为3.7（0.4 - 14.3）岁。有76例（62.8%）首次通过成功，儿科医生（25例，23%）或麻醉师（12例，11%）与所有其他医护人员（护理人员13例（12%）、急诊科医生37例（34%）、呼吸治疗师20例（18%）、转运团队2例（2%））之间无差异。AE的比例为24例（19.8%，21例轻微，3例严重），儿科医生或麻醉师与所有其他医护人员之间无显著差异。有68例转至SickKids的儿童的数据可用，大多数在入院后的中位（IQR）短时间内，即1.2（0.29 - 3.8）天拔管。
在加拿大以成人为主的社区医院系统中，儿科气管插管很少见。大多数插管显示首次通过成功，AE相对较少，且医护人员类型之间无显著差异。未来的研究应利用多中心数据来制定适合各机构独特实践文化的策略，包括培训项目。
