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Comparison of drugs used for intubation of pediatric trauma patients

Martina Mudri1, Andrew Williams1, Fran Priestap2

  • 1Division of General Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

Journal of Pediatric Surgery
|February 19, 2020
PubMed

Insights

Rapid sequence intubation (RSI) drugs like propofol may negatively impact pediatric traumatic brain injury (TBI) patients. This study found variability in drug use and potential adverse outcomes with propofol in pediatric TBI cases.

Area of Science:

  • Pediatric critical care medicine
  • Neurotrauma research
  • Pharmacology in emergency medicine

Background:

  • Rapid sequence intubation (RSI) is a critical procedure for securing the airway in emergent situations.
  • The choice of induction agents and paralytics during RSI can influence patient outcomes, particularly in vulnerable populations.
  • Limited data exists on the specific effects of RSI drugs on clinical outcomes in pediatric patients with traumatic brain injury (TBI).

Purpose of the Study:

  • To compare the clinical outcomes associated with different intubation drugs used in pediatric traumatic brain injury (TBI) patients.
  • To examine the variability in the use of induction agents and paralytics during RSI in this population.
  • To identify potential associations between specific RSI drugs and patient outcomes in pediatric TBI.

Main Methods:

  • Retrospective chart review and descriptive analysis of pediatric patients (ages 0-17) with TBI.
  • Data collected from Children's Hospital London Health Sciences Centre (LHSC) between January 2006 and December 2016.
  • Analysis included intubation success rates, drugs used, and clinical outcomes such as hospital length of stay and survival.

Main Results:

  • Of 107 pediatric TBI patients with complete data, the first-pass intubation success rate was 88.5%.
  • Propofol, midazolam, etomidate, and ketamine were the most frequently used induction agents; paralytics were used in 50% of cases.
  • Propofol use was associated with an increase in the Pediatric Adjusted Shock Index, indicating worsening hypotension. Mean hospital stay was 21 days (7.5 in ICU), with an 87% survival rate.

Conclusions:

  • Significant variability exists in the selection of induction agents and paralytics for RSI in pediatric TBI patients.
  • Propofol is a commonly used agent but may be associated with poorer clinical outcomes, including increased hypotension.
  • Further research is warranted to optimize RSI drug selection for improved outcomes in pediatric TBI.
Abstract

Keywords:
PediatricPropofolRapid sequence intubation (RSI)TraumaTraumatic brain injury (TBI)

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