Tracheal Tube Misplacement after Emergency Intubation in Pediatric Trauma Patients: A Retrospective, Exploratory Study

Abstract

Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of tube misplacement and associated factors of pediatric trauma patients who received ETI either by prehospital physician-staffed emergency medical service (EMS), or at emergency department (ED) admission to a single level-1 trauma center. Sixty-five patients (median age 14 years and median injury severity score 29) were included. Of these, 30 underwent helicopter EMS ETI, 29 ground EMS ETI, and 6 ED ETI. Seventeen cases (26%) of tracheal tube misplacement were recognized. After multivariable analysis, tracheal tube misplacement was independently negatively associated with body weight (OR 0.86; 95% CI, 0.76–0.99; p = 0.032) and helicopter EMS ETI (OR 0.20; 95% CI, 0.04–0.97; p = 0.036). Two of nineteen patients received tube thoracostomy due to endobronchial intubation. Mortality and length of stay were comparable in patients with misplaced tubes and correctly placed tubes. The results suggest that particularly small children require attention to avoid tracheal tube misplacement, which emphasizes the need for special training. Helicopter EMS physicians’ expertise might be beneficial in prehospital pediatric trauma patients requiring advanced airway management.

Epidemiological Analysis of the Emergency Vascular Access in Pediatric Trauma Patients: Single-Center Experience of Intravenous, Intraosseous, Central Venous, and Arterial Line Placements

“…However, 84.6% of patients received successful prehospital IV access, whereas 96.9% had prehospital IV or IO access. Other studies found overall success rates of prehospital IV access in 77%, 84% and 88.3% of cases [ 12 , 13 , 14 , 15 , 16 ]. First puncture attempt success rates in the literature range from 53% [ 17 ] and 67.8% [ 18 ] to 73% and 81% [ 19 ].…”

“…A dataset of consecutive acute pediatric major trauma patients requiring emergency tracheal intubation was reanalyzed regarding vascular access [ 13 ]. Ethical approval and retrospective registration were obtained by the Ethics Committee of the Medical Faculty of Leipzig, Germany (No.…”

Airway Management in Pediatric Patients: Cuff-Solved Problem?

“…The most common and serious complication is hypoxia, followed by cardiac dysrhythmias or even cardiac arrest, minor adverse events include dental or mucosal trauma, etc. It has been described that all these adverse events go hand in hand with repeated intubation attempts or the need for reintubation [ 84 ], caused by inappropriate tube size or tube misplacement [ 85 ]. As the incidence of both, misplacement and high air leak with a need to reintubate is lower in cuffed tubes [ 3 ], the use of cuffed tubes might prevent complications associated with emergency airway management.…”