Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC-NIC survey.

Autor: Foy KE; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK., Mew E; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK., Cook TM; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK., Bower J; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK., Knight P; Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK., Dean S; Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, UK., Herneman K; Department of Anaesthesia, Southmead Hospital, Bristol, UK., Marden B; Neonatal Intensive Care Unit, Royal United Hospital, Bath, UK., Kelly FE; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
Jazyk: angličtina
Zdroj: Anaesthesia [Anaesthesia] 2018 Nov; Vol. 73 (11), pp. 1337-1344. Date of Electronic Publication: 2018 Aug 15.
DOI: 10.1111/anae.14359
Abstrakt: In 2011, the Fourth National Audit Project (NAP4) reported high rates of airway complications in adult intensive care units (ICUs), including death or brain injury, and recommended preparation for airway difficulty, immediately available difficult airway equipment and routine use of waveform capnography monitoring. More than 80% of UK adult intensive care units have subsequently changed practice. Undetected oesophageal intubation has recently been listed as a 'Never Event' in UK practice, with capnography mandated. We investigated whether the NAP4 recommendations have been embedded into paediatric and neonatal intensive care practice by conducting a telephone survey of senior medical or nursing staff in UK paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs). Response rates were 100% for paediatric intensive care units and 90% for neonatal intensive care units. A difficult airway policy existed in 67% of paediatric intensive care units and in 40% of neonatal intensive care units; a pre-intubation checklist was used in 70% of paediatric intensive care units and in 42% of neonatal intensive care units; a difficult intubation trolley was present in 96% of paediatric intensive care units and in 50% of neonatal intensive care units; a videolaryngoscope was available in 55% of paediatric intensive care units and in 29% of neonatal intensive care units; capnography was 'available' in 100% of paediatric intensive care units and in 46% of neonatal intensive care units, and 'always available' in 100% of paediatric intensive care units and in 18% of neonatal intensive care units. Death or serious harm occurring secondary to complications of airway management in the last 5 years was reported in 19% of paediatric intensive care units and in 26% of neonatal intensive care units. We conclude that major gaps in optimal airway management provision exist in UK paediatric intensive care units and especially in UK neonatal intensive care units. Wider implementation of waveform capnography is necessary to ensure compliance with the new 'Never Event' and has the potential to improve airway management.
(© 2018 Association of Anaesthetists.)
Databáze: MEDLINE
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