Liu Kevin, Afreen Hajera, Sheldon Alexandra, Althubaiti Abdulrahman, Pattisapu Prasanth, Manning Amy, Lind Meridith, Grischkan Jonathan, Chiang Tendy
Department of Otolaryngology - Head & Neck Surgery, University of Florida, Gainesville, FL, USA.
Department of Otolaryngology, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA.
Int J Pediatr Otorhinolaryngol. 2024 Sep;184:112023. doi: 10.1016/j.ijporl.2024.112023. Epub 2024 Jun 25.
Endotracheal intubation (ETI) is a lifesaving procedure in critically ill children. Direct laryngoscopy (DL) is the most utilized method for ETI, however advanced techniques beyond DL are indicated in some patients. The purpose of this study is to describe trends of advanced ETI techniques in the critical care setting.
Using the National Emergency Airway Registry for Children (NEAR4KIDS), advanced technique ETI quality improvement data were prospectively collected for ETIs in PICUs from April 2018 to September 2021. Those who underwent ETI with only DL or who underwent exchange of an existing endotracheal tube were excluded.
A total of 79 patients underwent advanced technique ETI with a median age of 8 (IQR 1-17) years. Advanced technique ETI was successful on the first attempt in 46.8 % of cases, with an overall success rate of 91.1 %. 1.3 % of patients received emergent surgical airway management. The most utilized advanced ETI technique was video laryngoscopy, followed by flexible bronchoscopy, and intubation through a laryngeal mask airway (LMA). The provider discipline ultimately successful in performing advanced technique ETI was most often pediatric critical care medicine (n = 26, 32.9 %), followed by anesthesia (n = 20, 25.3 %), and otolaryngology (n = 16, 20.3 %).
While often indicated in challenging clinical scenarios, advanced ETI techniques are ultimately successful in the vast majority of cases. Advanced technique ETI is a highly multidisciplinary process.
气管插管术（ETI）是危重症儿童的一项挽救生命的操作。直接喉镜检查（DL）是ETI最常用的方法，然而在一些患者中需要采用DL以外的先进技术。本研究的目的是描述危重症环境中先进ETI技术的应用趋势。
利用国家儿童紧急气道注册系统（NEAR4KIDS），前瞻性收集2018年4月至2021年9月期间儿科重症监护病房（PICU）中ETI的先进技术质量改进数据。排除仅接受DL进行ETI或进行现有气管导管更换的患者。
共有79例患者接受了先进技术ETI，中位年龄为8岁（四分位间距1 - 17岁）。先进技术ETI首次尝试成功率为46.8%，总体成功率为91.1%。1.3%的患者接受了紧急手术气道管理。最常用的先进ETI技术是视频喉镜检查，其次是可弯曲支气管镜检查，以及通过喉罩气道（LMA）插管。最终成功实施先进技术ETI的医疗人员专业最常见的是儿科重症医学（n = 26，32.9%），其次是麻醉科（n = 20，25.3%）和耳鼻喉科（n = 16，20.3%）。
虽然先进ETI技术常在具有挑战性的临床场景中使用，但在绝大多数情况下最终是成功的。先进技术ETI是一个高度多学科的过程。
