Anesthesia, Sedation, and Unplanned Extubation of Tracheal Intubation in Children with Severe Pneumonia

Abstract

We randomly divided 200 children with severe pneumonia who met the indications for tracheal intubation into 2 groups in this prospective study. One group that received dexmedetomidine for sedation was recorded as the dexmedetomidine group (n = 100), and the group that received midazolam for sedation was recorded as the midazolam group (n = 100). We compared the anesthesia sedation scores, time to fall asleep, time to wake up from anesthesia, related hemodynamic parameters, and adverse reactions between the two groups of children. The failure mode and effect analysis method (FMEA) was also used to investigate the causes of unplanned extubation (UEX) of tracheal intubation in 32 children with severe pneumonia. Our conclusion is as follows: (1) Compared with midazolam, the comprehensive effect of dexmedetomidine on children with severe pneumonia undergoing tracheal intubation for anesthesia and sedation is better, it can effectively shorten the anesthesia induction time and the recovery time after stopping the drug, and there are few adverse reactions, which is worthy of application and promotion. (2) UEX is an important risk factor in the monitoring and nursing of children with severe pneumonia tracheal intubation, and the nursing method of PDCA cycle management is particularly important for them.

Literature Review on Interventions for Prevention of Unplanned Extubation in Nicu Picu: A Philosophy of Nursing Science

“…Installing an ETT on a child can cause physical discomfort to the child and trigger a stress response. Children who are mechanically ventilated will receive appropriate sedation (Morton et al, 2021,Wang et al, 2021)…”

“…Midazolam is currently a sedative commonly used for mechanical ventilation in children, but it has many disadvantages, because it is not effective in inhibiting the stress response caused by ETT (Wang et al, 2021). Midazolam can be administered orally, rectally, intramuscularly (IM), and intravascularly (IV).…”

“…Installing an ETT on a child can cause physical discomfort to the child and trigger a stress response. Children who are mechanically ventilated will receive appropriate sedation (Morton et al, 2021,Wang et al, 2021 Midazolam is currently a sedative commonly used for mechanical ventilation in children, but it has many disadvantages, because it is not effective in inhibiting the stress response caused by ETT (Wang et al, 2021). Midazolam can be administered orally, rectally, intramuscularly (IM), and intravascularly (IV).…”

“…UE is the unintentional disengagement of an ETT by a patient or healthcare worker (Crezeé et al, 2018) (Mahaseth et al, 2020). Causes of UE include oral grooming, turning and patting the back, restraints, and airway care (Wang et al, 2021) The impact of UE on children treated in the NICU and PICU is around 20% have cardiovascular collapse and require cardiopulmonary resuscitation (Kandil et al, 2018). Most of the cases (91.7%) of EU are taken seriously accidents that have the potential to result in arrhythmia and aspiration (Chao et al, 2017).…”

“…UE is the unintentional disengagement of an ETT by a patient or healthcare worker (Crezeé et al, 2018)(Mahaseth et al, 2020). Causes of UE include oral grooming, turning and patting the back, restraints, and airway care (Wang et al, 2021)…”