Department of Anesthesiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Department of Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Paediatr Anaesth. 2024 Jan;34(1):60-67. doi: 10.1111/pan.14757. Epub 2023 Sep 12.
Intrahospital transport is associated with adverse events. This challenge is amplified during airway management. Although difficult airway response teams have been described, little attention has been paid to patient transport during difficult airway management versus the alternative of managing patient airways without moving the patient. This is especially needed in a 22-floor vertical hospital.
Development of a rapid difficult airway response team and an associated difficult airway cart will allow for the ability to manage difficult airways in the patient's primary location.
A retrospective chart review of all rapid difficult airway response activations from December 18, 2019 to December 31, 2021 was performed to determine the number of airways secured in the patient's primary location (primary outcome). Secondary outcomes included length of time until airway securement, airway device used, number of attempts, complications, use of front of neck access, and mortality.
There were 96 rapid difficult airway response activations in a 2-year period, with 18 activations deemed inappropriate. Of the 78 indicated rapid difficult airway response deployments, all activations resulted in a secure airway, and 76 (97.4%) of cases had an airway secured in the patient's primary location. The mean time to airway securement was 17.1 min (standard deviation 18.8 min). The most common methods of airway securement were direct laryngoscopy (42.3%, 33/78) and video laryngoscopy (29.5%, 23/78). The mean number of attempts by the rapid difficult airway response team was 1.4. There were no documented cases requiring front of neck access. The Cormack-Lehane airway grade at time of intubation was I-II in 83.3% (65/78) of activations. Rapid difficult airway response activation resulted in 16 cases of cardiac arrest and 4 patient deaths within 48 h.
A rapid difficult airway response team allows a large majority of patients' airways to be managed and secured in the patient's primary hospital location. Future directions include reducing time to airway securement and identifying factors associated with cardiac arrest.
院内转运与不良事件相关。在气道管理过程中，这一挑战更为突出。虽然已经描述了困难气道反应团队，但对于在不移动患者的情况下管理患者气道与患者转运之间的选择，关注甚少。在一家 22 层的垂直医院，这一点尤为重要。
快速困难气道反应团队的发展和相关困难气道车的配备将使我们能够在患者的主要位置处理困难气道。
对 2019 年 12 月 18 日至 2021 年 12 月 31 日期间所有快速困难气道反应激活的回顾性图表进行了回顾，以确定在患者的主要位置（主要结果）安全气道的数量。次要结果包括气道安全的时间、气道设备的使用、尝试次数、并发症、使用前颈部通道和死亡率。
在 2 年期间，有 96 次快速困难气道反应激活，其中 18 次被认为不适当。在 78 次有指征的快速困难气道反应部署中，所有激活都导致了气道的安全，76 例（97.4%）患者在其主要位置建立了气道。气道安全的平均时间为 17.1 分钟（标准差 18.8 分钟）。气道安全最常用的方法是直接喉镜（42.3%，33/78）和视频喉镜（29.5%，23/78）。快速困难气道反应团队的平均尝试次数为 1.4 次。没有记录到需要前颈部通道的病例。插管时的 Cormack-Lehane 气道分级在 83.3%（65/78）的激活中为 I-II 级。快速困难气道反应激活导致 16 例心脏骤停和 4 例患者在 48 小时内死亡。
快速困难气道反应团队使大多数患者的气道能够在其主要的医院位置得到管理和安全。未来的方向包括减少气道安全的时间，并确定与心脏骤停相关的因素。
