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

Children

Manuel Florian Struck¹  Thomas Schwarz¹  Franziska Rost¹  Bernd Donaubauer¹  Sebastian Ebel²  Christian Kleber³  Peter Zimmermann⁴  Martin Lacher⁴  Holger Kirsten⁵  Daniel Gräfe⁶  Manuela Siekmeyer⁷ 

[1] Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103 Leipzig, Germany;Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, 04103 Leipzig, Germany;Department of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany;Department of Pediatric Surgery, University Hospital Leipzig, 04103 Leipzig, Germany;Institute for Medical Informatics Statistics and Epidemiology, Medical Faculty Leipzig, 04107 Leipzig, Germany;Institute of Pediatric Radiology, University Hospital Leipzig, 04103 Leipzig, Germany;Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital Leipzig, 04103 Leipzig, Germany;

关键词: pediatric trauma;    tracheal intubation;    airway management;    helicopter emergency medical service;   

DOI  :  10.3390/children9020289

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown