Endotracheal Intubations in a Pediatric Emergency Department

Objective: To describe the indications and diagnoses, methods, success rates, and immediate complications of endotracheal intubations performed in a pediatric emergency department (PED).

Design: Observational, consecutive series. Setting: ED of an urban pediatric teaching hospital with 50,000 annual patient visits. Subjects: All patients who were intubated in the ED from

6/96-11/98. Results: During the 30 month study period, 91 patients were intubated, a median of 3.0 intubations/month. The median age was 4 years (range 0-27 years). Indications for

intubation were neurologic disease in 34 patients (37%), respiratory distress/arrest/apnea in 26 (29%), trauma in 16 (18%), ingestion in 11 (12%) and other in 4 (4%). Of the patients with

neurologic disease, 29 (85%) presented in status epilepticus. Of the patients with respiratory disease, 6 had an underlying neuromuscular disorder, 6 were either premature or former

premature infants, 2 had anatomically abnormal airways and 2 were immunosuppressed. 7/26 (27%) patients with respiratory disease had positive tests for respiratory syncytial virus. Alcohol

and anticonvulsants (6/11) were the most common toxins resulting in intubation. All patients who required intubation were successfully intubated in the ED. Seventy-five of the patients

(82.4%) were successfully intubated on the first attempt, 10 (11.0%) were intubated on the second attempt, and 6 (6.6%) required more than 2 attempts. Rapid sequence intubation was used in

76 (83.5%) of the patients. The first time success rate for patients who underwent rapid sequence intubation was significantly higher than non-rapid sequence patients (86.8% vs. 60.0%,

P=0.02). Complications reported were right main stem intubation (3 patients), laryngospasm (2) and aspiration (1). There were no long-term sequelae from these complications (95% CI 0-3.3%).

One patient died in the ED and three patients died during their admission. Conclusion: In our pediatric. ED, patients were intubated with a high success rate and a low complication rate.

Rapid sequence induction appears to offer a safe and successful adjunct for endotracheal intubation.

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