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Guidelines for Elective Pediatric Fiberoptic Intubation
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Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

17.8K

Initiative to Improve Postintubation Sedation in a Pediatric Emergency Department

Whitney W Irwin, Kathleen T Berg, Timothy K Ruttan

    Journal for Healthcare Quality : Official Publication of the National Association for Healthcare Quality
    |December 29, 2021
    PubMed

    Insights

    Implementing an intubation checklist and a multidisciplinary approach significantly improved timely pediatric postintubation sedation (PIS), increasing adequate PIS rates by over 27% and reducing variability.

    Area of Science:

    • Pediatric Critical Care Medicine
    • Patient Safety
    • Quality Improvement Initiatives

    Background:

    • Appropriate pediatric postintubation sedation (PIS) after rapid sequence intubation (RSI) is administered in only 28% of cases.
    • High provider variability, cognitive overload, and errors of omission contribute to delays in PIS for paralyzed pediatric patients.

    Purpose of the Study:

    • To enhance the proportion of children receiving timely PIS by 20% within a 6-month period.

    Main Methods:

    • A multidisciplinary team identified key drivers of PIS delay and implemented targeted interventions.
    • Defined "adequate time frame" for PIS as sedative administration within the duration of action of the RSI sedative agent.
    • Monitored primary and secondary outcomes, including the proportion of patients receiving any PIS and time to PIS administration.

    Main Results:

    • Adequate PIS improved from 27.9% to 55.6% (p = .001) post-intervention.
    • The overall proportion of patients receiving any PIS increased from 74% to 94% (p = .006).
    • Median time from RSI to PIS decreased from 13 to 9 minutes (p < .001), with reduced variability.

    Conclusions:

    • An intubation checklist and a multidisciplinary strategy effectively improved the rate of adequate pediatric PIS.
    • These interventions successfully addressed delays and variability in PIS administration.
    Abstract

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