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Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Airway management in the pediatric emergency department in Japan: A multicenter prospective observational study
Yusuke Hagiwara1, Tadahiro Goto2, Shima Ohnishi3
1Department of Pediatric Emergency and Critical Care Medicine Tokyo Metropolitan Children's Medical Center Tokyo Japan.
Insights
Pediatric tracheal intubation in Japan has a 72% first-attempt success rate. Success varies significantly based on intubation location, patient factors, and provider experience in emergency departments (EDs).
Area of Science:
- Pediatric Emergency Medicine
- Airway Management
- Resuscitation Science
Background:
- Tracheal intubation is a critical resuscitation procedure in pediatric emergency departments (EDs).
- Limited data exists on current emergency airway management practices in Japan.
- Understanding factors influencing intubation success is crucial for improving pediatric care.
Purpose of the Study:
- To investigate airway management characteristics in Japanese pediatric EDs.
- To identify factors influencing tracheal intubation success.
- To analyze variations in intubation based on location, patient, and provider.
Main Methods:
- A multicenter, prospective study was conducted in five Japanese pediatric EDs (October 2018 - June 2020).
- Included children (≤18 years) undergoing intubation in pre-ED or ED settings, or transferred for intubation.
- Described airway management characteristics by location, patient demographics, and provider factors.
Main Results:
- Of 231 children, 222 underwent intubation in pre-ED (45) or ED (177) settings.
- Overall first-attempt intubation success rate was 72%.
- Success rates varied: 68% in pre-ED, 67% for children <2 years, 56% for those with anomalies, and 61% with resident physicians. Adverse events occurred in 17%, primarily hypoxemia (14%).
Conclusions:
- The first-attempt tracheal intubation success rate in Japanese pediatric EDs is 72%.
- Significant variations in success rates were observed across different locations, patient populations, and provider types.
- Further research is needed to optimize pediatric airway management strategies in emergency settings.
Aim:
Tracheal intubation is a vital resuscitation procedure in the pediatric emergency department (ED). Despite its importance, little is known about the current status of emergency airway management in Japan. In this context, we aimed to investigate the airway management characteristics-particularly the location, patient, and provider factors-in the pediatric ED.
Methods:
We conducted a multicenter, prospective study of five pediatric EDs in Japan from October 2018 to June 2020. The study included all children (aged ≤18 years) who underwent intubation at the pre-ED or ED setting by physicians and those who were transferred from the ED to the operation room (OR) or pediatric intensive care unit (PICU) for intubation. We described the airway management characteristics according to the location, patient, and provider factors.
Results:
Of 231 children, 9 (4%) were transferred to the OR or PICU for airway management. Among the remaining 222 children, 45 were intubated at the pre-ED setting and 177 were intubated in the ED. The overall first-attempt success rate was 72%, with the rate varying by location, patient, and provider factors-for example, 68% at the pre-ED setting, 67% for children <2 years, 56% for children with airway-related anatomical anomalies, and 61% with intubation by a resident physician. Intubation-related adverse events were observed in 17%, most of which were hypoxemia (14%).
Conclusions:
Based on data from a multicenter prospective study, the overall first-attempt intubation success rate in pediatric EDs in Japan was 72%, with large variations by location, patient, and provider factors.
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