Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma: a descriptive study

Simons, Tomi; Söderlund, Tim; Handolin, Lauri

doi:10.1007/s00068-016-0758-2

Cited by 14 publications

(18 citation statements)

References 29 publications

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“…Reporting of airway training was too heterogeneous to support an analysis however. Some studies provided no description of training [19,21,24,26,39,44,45], and some reported pooled data from multiple agencies [3,28,32], whilst others described the studied teams simply as Advanced Life Support and/or Paediatric Advanced Life Support certified [5,20,[33][34][35].…”

Section: Discussionmentioning

confidence: 99%

“…As there was no inter-group heterogeneity for endobronchial intubation (P = 0.15), the overall pooled estimated was 7% (95% CI 3-12%) ( Table 2). However, Simons and colleagues' study [44] appears to be an outlier (21%, 95% CI 10-37%) as there were exhaustive attempts to determine the endotracheal tube position after arrival in the emergency department. A post hoc sensitivity analysis, excluding Simons and colleagues' study [44], showed that there was a significant inter-group heterogeneity (P < 0.001), with a pooled estimate for physician team decreasing to 0% (95% CI 0-2%).…”

Section: Adverse Eventsmentioning

confidence: 98%

“…Seven studies were in trauma patients (n = 500) [21,26,34,[39][40][41]44], six in arrested patients (n = 804) [5,17,25,29,33,38], and three in head injury patients (n = 414) [6,31,37], and the remaining studies comprised a mixed population of all patients requiring airway management (n = 9849). There was no association between team composition and type of paediatric patients treated (P = 0.875).…”

Section: Outcomes By Clinical Populationmentioning

confidence: 99%

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Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

et al. 2020

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Background: Clinical team composition for prehospital paediatric intubation may affect success and complication rates. We performed a systematic review and meta-analysis to determine the success and complication rates by type of clinical team. Methods: We searched MEDLINE, EMBASE, and CINAHL for interventional and observational studies describing prehospital intubation attempts in children with overall success, first-pass success, and complication rates. Eligible studies, data extraction, and assessment of risk of bias were assessed independently by two reviewers. We performed a random-effects meta-analysis of proportions. Results: Forty studies (1989 to 2019) described three types of clinical teams: non-physician teams with no relaxants (22 studies, n = 7602), non-physician teams with relaxants (12 studies, n = 2185), and physician teams with relaxants (12 studies, n = 1780). Twenty-two (n = 3747) and 18 (n = 7820) studies were at low and moderate risk of bias, respectively. Non-physician teams without relaxants had lower overall intubation success rate (72%, 95% CI 67-76%) than non-physician teams with relaxants (95%, 95% CI 93-98%) and physician teams (99%, 95% CI 97-100%). Physician teams had higher first-pass success rate (91%, 95% CI 86-95%) than non-physicians with (75%, 95% CI 69-81%) and without (55%, 95% CI 48-63%) relaxants. Overall airway complication rate was lower in physician teams (10%, 95% CI 3-22%) than non-physicians with (30%, 95% CI 23-38%) and without (39%, 95% CI 28-51%) relaxants. Conclusion: Physician teams had higher rates of intubation success and lower rates of overall airway complications than other team types. Physician prehospital teams should be utilised wherever practicable for critically ill children requiring prehospital intubation.

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Section: Discussionmentioning

confidence: 99%

Section: Adverse Eventsmentioning

confidence: 98%

Section: Outcomes By Clinical Populationmentioning

confidence: 99%

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Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

et al. 2020

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“…Within this context, different techniques should be used to determine where the orotracheal tube should be placed correctly, including a physical examination where epigastric sounds are not heard during ventilation, a chest X-ray to visualize the orotracheal tube, capnography curve, expired CO 2 value of >30 mm Hg, or steam water on the orotracheal tube walls. If any of these signs are altered, the risk of tube misplacement should be considered, which can cause additional complications to esophageal intubation such as bronchoaspiration, esophageal perforation, hypoxia, atelectasis, or even irreversible brain injury caused by hypoxia or death [30][31][32].…”

Section: Discussionmentioning

confidence: 99%

“…It should be highlighted that trauma is the most observed clinical condition in all papers included in this systematic review, which implies several particular characteristics of this patient type, possibly aggravating scenarios, and has a direct effect on outcomes. In this context, difficulties in airway approach related to physiological factors can be observed owing to injury mechanisms, which cause quick patient deterioration, as well as anatomical factors caused by the trauma itself, such as airway bleeding and anatomical integrity alterations [25,32].…”

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Failure of Prehospital Endotracheal Intubation in Pediatric Patients

Rodríguez

Higuita-Gutiérrez

Garcia

et al. 2020

Emergency Medicine International

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Prehospital care is essential for airway preservation in pediatric patients who require early endotracheal intubation to improve oxygenation and prevent aspiration. However, high frequencies of failure of endotracheal intubation have been reported for this age group. We aimed to analyze the frequency of failure of endotracheal intubation in pediatric patients within a prehospital context and compare it with adult patients. Thus, a systematic revision of literature with a meta-analysis was performed using a study search and selection strategy ensuring extensiveness, sensitivity, and reproducibility. Meta-analyses were performed for odds ratio, DerSimonian and Laird’s Q test was used to assess heterogeneity, and Egger and Begg’s test was used to assess publication bias. Overall, 17 papers and 8772 patients were included, and the main cause of prehospital care was assessed to be trauma. Failed endotracheal intubation frequency was 0.4%–52.6% in pediatric patients. The most frequent complication was with esophageal intubation. Forest plot suggests that risk of failure during intubation of pediatric patients is 3.54 fold higher than that observed for adults. It was concluded that airway management in pediatric patients within a prehospital context is a challenge for prehospital care providers because it entails clear physiological and anatomical differences and a low frequency of exposure to this kind of events as opposed to adults. These differences support a widely higher risk of failure of intubation, suggesting the necessity of consistently trained prehospital care providers to ensure proficiency in technique as well as availability of the required equipment.

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Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

Voorde

Turner

Djakow

et al. 2021

Notfall Rettungsmed

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Die Leitlinien des European Resuscitation Council (ERC) zu den lebensrettenden Maßnahmen bei Kindern (Paediatric Life Support, PLS) basieren auf dem 2020 verfassten „International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations“ der ILCOR (International Liaison Committee on Resuscitation). Dieses Kapitel beinhaltet Leitlinien zur Behandlung kritisch kranker oder verletzter Säuglinge, von Kindern und Jugendlichen vor, während und nach einem Atem-Kreislauf-Stillstand.

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Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma: a descriptive study

Abstract: Pediatric endotracheal tube intubation carries a high rate of tube malposition and left lung atelectasis in our experience of pediatric trauma patients, with less than a third of ETTs placed in a safe position.

Cited by 14 publications

References 29 publications

Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

Success and complications by team composition for prehospital paediatric intubation: a systematic review and meta-analysis

Meta-Analysis of Failure of Prehospital Endotracheal Intubation in Pediatric Patients

Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS)

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