Endotracheal intubations in a pediatric emergency department

ABSTRACT 461 _Poster Session III, Monday, 5/3 (poster 188)_ 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. AUTHOR

INFORMATION AUTHORS AND AFFILIATIONS * Division of Emergency Medicine, Department of Emergency Medicine, Children's Hospital, Brigham and Women's Hospital, Harvard Medical School,

Boston, MA Vincent W Chiang, Mark J Sagarin & Ron M Walls Authors * Vincent W Chiang View author publications You can also search for this author inPubMed Google Scholar * Mark J Sagarin

View author publications You can also search for this author inPubMed Google Scholar * Ron M Walls View author publications You can also search for this author inPubMed Google Scholar

ADDITIONAL INFORMATION (Spon by: Gary R Fleisher) RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Chiang, V., Sagarin, M. & Walls, R. Endotracheal

Intubations in a Pediatric Emergency Department. _Pediatr Res_ 45, 80 (1999). https://doi.org/10.1203/00006450-199904020-00478 Download citation * Issue Date: 01 April 1999 * DOI:

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