Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma : a descriptive study
| Autor: | Tim Söderlund, T. Simons, Lauri Handolin |
|---|---|
| Přispěvatelé: | Clinicum, Department of Surgery, I kirurgian klinikka (Töölö), University of Helsinki, HUS Musculoskeletal and Plastic Surgery |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Emergency Medical Services medicine.medical_treatment Atelectasis CHILDREN CUFF Critical Care and Intensive Care Medicine Safe zone 0302 clinical medicine Trauma Centers 030202 anesthesiology Outcome Assessment Health Care Intubation Orthopedics and Sports Medicine Thoracotomy Child Tip-to-carina distance Finland DISPLACEMENT Trauma center Age Factors respiratory system 3. Good health Trachea Near miss intubation Emergency Medicine Female TIP POSITION AIRWAY MANAGEMENT Pediatric trauma medicine.medical_specialty Chest injury Tracheal tube 03 medical and health sciences Pediatric prehospital endotracheal intubation medicine Intubation Intratracheal Humans TRACHEAL TUBE Retrospective Studies business.industry Multiple Trauma 030208 emergency & critical care medicine medicine.disease 3126 Surgery anesthesiology intensive care radiology Surgery INJURY SEVERITY SCORE Airway management business Complication Pediatric intubation |
| Popis: | Purpose Pediatric prehospital endotracheal intubation (PHETI) is a difficult and rarely performed procedure that remains the gold standard for prehospital airway management when ventilation and/or anesthesia is required, but high complications rates, including malposition continue to concern. We reviewed the experience in our institution of pediatric intubations with particular emphasis on the position of the endotracheal tube (ETT) tip within the trachea and related complications. Method Intubated pediatric patients presenting directly from the scene to our level 1 trauma center, between 2006 and 2014, were included in our study. Patient records and radiographs were retrospectively reviewed to identify the ETT tip-to-carina distance and possible intubation-related complications. ETT tips identified beyond the carina on radiographs or by clinical diagnosis were defined as misplaced. Because head movement causes a significant ETT movement within the trachea, which is age related, we also defined ETT tip placement (1) less than 2 cm above the carina in children younger than 8 and (2) less than 3 cm above the carina in children 8 years or older as "near miss" intubations. Results From a total of 34 cases, ETT misplacement was identified in seven cases. Diagnosis was made radiologically in five cases and clinically in two cases. Four of these patients had left lung atelectasis due to tube misplacement. Tube thoracotomy was performed in two of these patients without concurrent evidence of chest injury. "Near miss" intubations accounted for 7/9 and 9/25 in children = 8 years old, respectively, totaling 16/34, with two of these leading to late displacements. Conclusions 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. |
| Databáze: | OpenAIRE |
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