A multidisciplinary, video-based, curriculum for management of the intubated and surgical airway patient for a pediatric hospital in El Salvador.

Autor: Ghersin ZJ; Massachusetts General Hospital for Children, Boston, MA, USA. Electronic address: zghersin@mgh.harvard.edu., Yager P; Massachusetts General Hospital for Children, Boston, MA, USA. Electronic address: pyager@mgh.harvard.edu., Cummings BM; Massachusetts General Hospital for Children, Boston, MA, USA. Electronic address: bmcummings@mgh.harvard.edu., Hersh M C; Massachusetts General Hospital for Children, Boston, MA, USA. Electronic address: cjhersh@mgh.harvard.edu., Cayer M; Massachusetts Eye and Ear, Boston, MA, USA. Electronic address: Makara_Cayer@meei.harvard.edu., Callans KM; Massachusetts Eye and Ear, Boston, MA, USA. Electronic address: Kevin_Callans@meei.harvard.edu., Zablah EJ; Massachusetts Eye and Ear, Boston, MA, USA. Electronic address: evelynzablah@gmail.com., Gallagher T; Children's Hospital of the King's Daughters, Norfolk, VA, USA. Electronic address: Thomas.Q.Gallagher@gmail.com., Abrego S; Hospital de Niños Benjamin Bloom, San Salvador, El Salvador. Electronic address: susanabrego2001@yahoo.com.mx., Bonilla J; Hospital de Niños Benjamin Bloom, San Salvador, El Salvador. Electronic address: alfbonii@yahoo.com., Vela OS; Hospital de Niños Benjamin Bloom, San Salvador, El Salvador. Electronic address: oscarsanchezvela@hotmail.com., Guzman L; Hospital de Niños Benjamin Bloom, San Salvador, El Salvador. Electronic address: licoguzman@yahoo.com.mx., Aguilar A; Hospital de Niños Benjamin Bloom, San Salvador, El Salvador. Electronic address: alejandrabeatriza@yahoo.com., Hartnick CJ; Massachusettes Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA. Electronic address: Christopher_Hartnick@meei.harvard.edu.
Jazyk: angličtina
Zdroj: International journal of pediatric otorhinolaryngology [Int J Pediatr Otorhinolaryngol] 2020 Jan; Vol. 128, pp. 109732. Date of Electronic Publication: 2019 Oct 15.
DOI: 10.1016/j.ijporl.2019.109732
Abstrakt: Objective: Primary objective is to determine the rate of intubation with inappropriately sized endotracheal tubes (ETTs) in a pediatric intensive care unit (PICU) in El Salvador. Secondary objective is to determine effectiveness of a video-based curriculum to teach local providers on pediatric advanced airway management and surgical approach to patients requiring airway reconstruction.
Methods: Data for 296 intubated pediatric patients was collected over a six month period in a 16-bed PICU in El Salvador. Results of a learning behavior assessment survey completed by local healthcare workers informed a curriculum to complement on-site education during annual surgical airway mission trips. The video-based curriculum addressed proper sizing and use of cuffed endotracheal tubes, care of the intubated child and perioperative considerations of the surgical airway patient. Providers completed pre and post-curriculum quizzes to measure knowledge acquisition.
Results: Over 6-months, 281 patients were intubated. Sixty-three percent had improperly sized ETTs. Thirty-one percent had a failed or accidental extubation. All-cause mortality was 24%. One hundred and fifty-nine Salvadorian providers completed a learning behavior survey informing a video-based curriculum. Sixty-four providers completed the curriculum. Post-curriculum quiz scores increased by 18.7%. Surgeons, anesthesiologist, intensivists and speech pathologists demonstrated significant improvement (p < 0.05).
Conclusion: Nearly two-thirds of intubated patients in a PICU in El Salvador have improperly sized ETTs and one-third require reintubation following planned or accidental extubation. The development of this first of its kind video-based curriculum for critical care and surgical training regarding how to properly care for the intubated child is coupled with the development of a longitudinal database to record pediatric airway related morbidity and mortality in the largest pediatric hospital in El Salvador. This model and system can be used to track the reduction in airway related morbidity and mortality directly related to a systems based intervention both in El Salvador and then elsewhere.
(Copyright © 2019 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: