Advances in Emergent Airway Management in Pediatrics

Miller, Kelsey A.; Nagler, Joshua

doi:10.1016/j.emc.2019.03.006

Cited by 47 publications

(50 citation statements)

References 63 publications

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“…This may be associated with the fact that younger children are more difficult when dealing with sedation, they use artificial airways that are smaller in caliber, they salivate more, in addition to specific anatomical characteristics of the airways that make them more prone to events. 30,31 AE is characterized by unintentional injury or damage caused to the patient from the assistance intervention and not by the underlying disease, while complications can originate from the underlying disease. However, the relevant similarity is that AE and complications associated with the diseases can be avoided by implementing prevention protocols.…”

Section: Discussionmentioning

confidence: 99%

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Adverse Events Related to Mechanical Ventilation in a Pediatric Intensive Care Unit

Martins

Ferreira

Kakehasi

2021

Rev. paul. pediatr.

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Objective: To identify the prevalence and factors associated with adverse events (AE) related to invasive mechanical ventilation in patients admitted to the Pediatric Intensive Care Unit (PICU) of a tertiary public hospital. Methods: This is a cross-sectional study from July 2016 to June 2018, with data collected throughout patients’ routine care in the unit by the care team. Demographic, clinical and ventilatory characteristics and adverse events were analysed. The logistic regression model was used for multivariate analysis regarding the factors associated with AE. Results: Three hundred and six patients were included, with a total ventilation time of 2,155 days. Adverse events occurred in 66 patients (21.6%), and in 11 of those (16.7%) two AE occurred, totalling 77 events (36 AE per 1000 days of ventilation). The most common AE was post-extubation stridor (25.9%), followed by unplanned extubation (16.9%). Episodes occurred predominantly in the afternoon shift (49.3%) and associated with mild damage (54.6%). Multivariate analysis showed a higher occurrence of AE associated with length of stay of 7 days or more (Odds Ratio [OR]=2.6; 95% confidence interval [95%CI] 1.49-4.66; p=0.001). Conclusions: The results of the present study show a significant number of preventable adverse events, especially stridor after extubation and accidental extubation. The higher frequency of these events is associated with longer hospitalization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Adverse Events Related to Mechanical Ventilation in a Pediatric Intensive Care Unit

Martins

Ferreira

Kakehasi

2021

Rev. paul. pediatr.

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“…Rapid endotracheal intubation reduces the risk of hypoxia and allows the introduction of mechanical ventilation with a ventilator, allowing the medical personnel to focus on other procedures [26,27]. This is particularly important in the context of emergency teams, where a limited number of personnel in the team forces therapeutic compro-mises.…”

Section: Discussionmentioning

confidence: 99%

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

Karczewska

Smereka

Dąbrowski

et al. 2020

Disaster Emerg Med J

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InTRoDuCTIon:Endotracheal intubation is one of the basic procedures performed in emergency medicine in patients with respiratory insufficiency, inability to maintain airway patency, or apnoea. Rapid performance of the procedure and implementation of ventilation are among the basic principles of rescue procedures. The primary aim of the present systematic review and meta-analysis was to compare the VivaSight single lumen (SL) tube-mounted camera with a standard endotracheal single-lumen tube and direct laryngoscope for endotracheal intubation based on randomised controlled trials of simulation or cadaver trials. The analysis was based on the hypothesis that the use of videolaryngoscopy based on VivaSight SL tube increases the effectiveness of endotracheal intubation, reducing the risk of ineffectiveness of the first intubation attempt and the risk of adverse events, such as dental compression. MATeRIAL AnD MeThoDS:We searched the MEDLINE, EMBASE, Scopus, Cochrane, and Google Scholar databases for randomised, controlled trials and observational studies from 1985 until October 2019, without language restrictions. Grey literature, clinicaltrials.gov, and reference lists of articles were hand searched. We conducted a meta-analysis with random-effects models to evaluate time to intubation, first-pass success rates, overall success rates, dental compression, and glottic view. ReSuLTS:The search located 12 eligible studies. The time of intubation using VivaSight was significantly shorter than that of direct laryngoscopy (MD = -11.29 [-13.10, -9.49], p < 0.001). The efficacy of the first intubation attempt was higher for VivaSight than for double lumen (DL) (96.0% vs. 61.7%; RR = 1.62 [1.40, 1.88], p < 0.001). The meta-analysis showed that the total efficacy of VivaSight intubation compared to direct laryngoscopy was statistically significantly higher (100% vs. 88.9%, RR = 1.11 [1.02, 1.20]; p = 0.02). The glottis visibility assessed as Cormack-Lehane grade I or II was better in VivaSight intubation compared to direct laryngoscopy (100% vs. 90.9%, RR = 1.05 [0.99, 1.12]; p = 0.08). ConCLuSIonS:Our meta-analysis suggests that the VivaSight SL provided better glottic visualisation and shorter intubation time, with improved success rates during different simulated intubation scenarios.

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“…Airway management and other aerosol-generating procedures (AGP) Any AGP (specifically intubation) has to be considered a high-risk procedure given the likelihood of aerosol spread from the patient [19][20][21][22][23][24] (Table 2).…”

Section: Any Infantmentioning

confidence: 99%

European consensus recommendations for neonatal and paediatric retrievals of positive or suspected COVID-19 patients

et al. 2020

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BACKGROUND: The 2020 novel coronavirus (SARS-Cov-2) pandemic necessitates tailored recommendations addressing specific procedures for neonatal and paediatric transport of suspected or positive COVID-19 patients. The aim of this consensus statement is to define guidelines for safe clinical care for children needing inter-facility transport while making sure that the clinical teams involved are sufficiently protected from SARS-CoV-2. METHODS: A taskforce, composed of members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Transport section and the European Society for Paediatric Research (ESPR), reviewed the published literature and used a rapid, twostep modified Delphi process to formulate recommendations regarding safety and clinical management during transport of COVID-19 patients. RESULTS: The joint taskforce consisted of a panel of 12 experts who reached an agreement on a set of 17 recommendations specifying pertinent aspects on neonatal and paediatric COVID-19 patient transport. These included: case definition, personal protective equipment, airway management, equipment and strategies for invasive and non-invasive ventilation, special considerations for incubator and open stretcher transports, parents on transport and decontamination of transport vehicles. CONCLUSIONS: Our consensus recommendations aim to define current best-practice and should help guide transport teams dealing with infants and children with COVID-19 to work safely and effectively.

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Advances in Emergent Airway Management in Pediatrics

Cited by 47 publications

References 63 publications

Adverse Events Related to Mechanical Ventilation in a Pediatric Intensive Care Unit

Adverse Events Related to Mechanical Ventilation in a Pediatric Intensive Care Unit

VivaSight single-lumen tube as an intubation method. A systematic review and meta-analysis of randomised simulation trials

European consensus recommendations for neonatal and paediatric retrievals of positive or suspected COVID-19 patients

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