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Protocol for rapid sequence intubation in pediatric patients -- a four-year study
Eduardo Marvez-Valls1, Debra Houry, Amy A Ernst
1Medical Center of New Orleans Section of Emergency Medicine, New Orleans, Louisiana, USA.
Insights
A protocol for rapid sequence intubation (RSI) in pediatric trauma patients demonstrated high success rates. This method proved effective in an emergency medicine residency program, with no complications from protocol deviations.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Trauma Surgery
Background:
- Rapid sequence intubation (RSI) is a critical procedure for pediatric patients requiring airway management.
- Evaluating established protocols is essential for optimizing patient outcomes in trauma centers.
Purpose of the Study:
- To assess the efficacy and safety of a protocol for pediatric rapid sequence intubation.
- To analyze intubation success rates and identify patient demographics and indications within a Level 1 trauma center.
Main Methods:
- Retrospective review of prospectively collected Continuing Quality Improvement (CQI) data.
- Analysis of 83 pediatric intubations performed between February 1996 and February 2000.
- Statistical analysis using descriptive statistics and Chi-square tests.
Main Results:
- Successful intubation in one attempt for 78% of cases.
- Trauma was the primary indication (86%), with motor vehicle collisions (MVCs) being the most common cause (55%).
- No complications arose from protocol deviations; rocuronium was used in 4 cases.
Conclusions:
- The protocol-based pediatric RSI method was effective within an emergency medicine residency program.
- Pediatric intubations were more frequent in males and predominantly due to trauma.
- The protocol supported safe and successful airway management in this pediatric trauma population.
Background:
To evaluate a protocol for rapid sequence intubation (RSI) for pediatric patients in a Level 1 trauma center.
Material/Methods:
Retrospective review of prospectively gathered Continuing Quality Improvement (CQI) data at an inner city Level 1 trauma center with an emergency medicine residency program. Protocols for RSI were established prior to initiating the study. All pediatric intubations at the center from February 1996 to February 2000 were included. Statistical analysis included descriptive statistics for categorical data and Chi-square for comparisons between groups.
Results:
Over the 4-year study period there were 83 pediatric intubations ranging in age from 18 months to 17 years; mean age 8.6. All had data collected at the time of intubation. There were 20 (24%) females and 62 (76%) males (p<0.001). Reasons for intubation were related to trauma in 71 (86%) and medical reasons in 12 (14%) (p<0.001). Of the trauma intubations 7 (10%) were for gunshot wounds, 39 (55%) were secondary to MVCs, and the remainder (25; 35%) were from assaults, falls, and closed head injuries. The non-trauma intubations were for smoke inhalation, overdose, seizure, HIV related complications, eclampsia, and near drowning. Intubations were successful with one attempt in 65 (78%) cases. No surgical airways were necessary. Rocuronium was used in 4 cases. Protocol deviations did not lead to complications.
Conclusions:
This protocol based pediatric rapid sequence intubation method worked well in an EM residency program. More intubations were in males and more were necessary due to trauma in this group.