Related Experiment Videos
Management of children with epiglottitis during transport: analysis of a survey
Y Waisman1, B L Klein, G M Young
1Emergency Medical Trauma Center, Children's National Medical Center, Washington, DC.
Insights
Physicians lack transport guidelines for pediatric epiglottitis. Current practices vary, with most centers using transport teams and nasal intubation, but few employing additional restraints for airway security.
Area of Science:
- Pediatric Critical Care
- Emergency Medicine
- Transport Medicine
Background:
- No standardized national guidelines exist for managing pediatric epiglottitis during transport.
- Current management practices among physicians are diverse and not well-documented.
Purpose of the Study:
- To survey physicians on current practices for pediatric epiglottitis transport.
- To identify correlations between management methods and transport complications.
Main Methods:
- A 22-item questionnaire was distributed to physicians at the 1990 Pediatric Critical Care Transport Leadership Conference.
- Survey addressed demographics, transport teams, airway management, medications, monitoring, and complications.
- Data collected from 43 of 49 attendees (87.8% response rate).
Main Results:
- Most respondents were pediatric intensivists or emergency physicians in tertiary care centers.
- 83% of centers had designated transport teams.
- Practices for intubation varied; nasal intubation was preferred. Securement methods included taping and paralytics, with limited use of restraints.
Conclusions:
- Significant variation exists in the management of pediatric epiglottitis during transport.
- Need for standardized guidelines to improve patient safety and outcomes.
- Further research needed to correlate specific management techniques with complication rates.
Abstract:
Because nationally accepted guidelines for the management of children with epiglottitis during transport have not been published, we surveyed physicians attending the 1990 Pediatric Critical Care Transport Leadership Conference in order to delineate current practices and to test for correlations between complications and methods of management. A 22-item questionnaire was distributed, addressing demographics, availability and composition of a designated transport team, methods of airway management, use of medications for sedation or paralysis, monitoring techniques, and complications encountered during transport. Forty-three of the 49 attendees completed the questionnaire (87.8%). Almost all were attending physicians (60.9% pediatric intensivists, 29.3% pediatric emergency physicians) practicing in tertiary care facilities (58.5% in children's hospitals, 41.5% in general hospitals). Eighty-three percent of centers had designated transport teams. For transfer of a child with suspected epiglottitis from a physician's office, virtually all respondents recommended transport by ambulance, 64% to the nearest facility and 36% directly to a tertiary care center. Regarding interhospital transfers, 49% recommended intubation prior to transport in all cases, whereas 49% considered it on an individual basis. The majority of respondents preferred nasal intubation. To prevent dislocation of the endotracheal tube, 79.1% recommended taping it to the face only (as opposed to around the skull), 70.7% administered paralytic agents, but only 35.2% used additional mechanical restraints.(ABSTRACT TRUNCATED AT 250 WORDS)