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Çocuk acil servisinde hızlı seri entübasyon deneyimlerimiz

Year 2023, Volume: 28 Issue: 1, 24 - 29, 20.01.2023
https://doi.org/10.21673/anadoluklin.1137449

Abstract

Amaç: Acil serviste hasta seçimi ve hızlı seri entübasyon (HSE) uygulamasının yönetimi klinisyenler için zor olabilir. Bu çalışmada hastanemiz çocuk acil servisinde HSE yapılan hastaların demografik ve klinik özelliklerini ile hasta yönetim stratejilerinin değerlendirilmesi amaçlandı.

Yöntemler: 1 Ocak 2021 ile 1 Ocak 2022 tarihleri arasında çocuk acil servisinde HSE uygulanan 18 yaşından küçük hastalar çalışmaya dâhil edildi.

Bulgular: Çalışmaya 11 hasta dâhil edildi. Hastaların medyan yaşı 6 (2-15) idi [minimum (min)-maksimum (maks)], 7’si kızdı (%63,6). Semptom başlangıcından başvuruya kadar geçen süre medyan değeri 120 dakikaydı (min-maks 15 dakika-2 hafta). HSE endikasyonları travma (n=5), kafa içi kitle (n=4), ventriküloperitoneal şant disfonksiyonu (n=1), dirençli status epileptikus (n=1) idi. Hastaların Glasgow Koma skala skorları ortanca değeri 8 (min-maks 4-15) idi. Hastaların tamamında fokal nörolojik defisit mevcuttu. İlk nörogörüntüleme yöntemi 10 (%90.9) hastada kraniyal tomografiydi ve beş hastada (%45,4) intrakraniyal kanama mevcuttu. HSE’ye bağlı hiçbir hastada komplikasyon izlenmedi. Hastalardan ikisi exitus oldu (intrakraniyal kanama ve şant disfonksiyonu nedeniyle). Birinci ay kontrollerinde beş hastada dizartri, yürüme bozukluğu, hemiparezi, görme bozukluğu gibi nörolojik defisitler tespit edildi.

Sonuç: Bu retrospektif çalışma, akut nörolojik semptomlarla acil servise başvuran ve kafa içi basıncının artmasını ve daha fazla beyin hasarını önlemek için HSE uygulanan kritik hasta çocukları tanımladı.

Project Number

Yoktur

References

  • Bennett BL, Scherzer D, Gold D, et al. Optimizing Rapid Sequence Intubation for Medical and Trauma Patients in the Pediatric Emergency Department. Pediatr Qual Saf. 2020;5(5):e353.
  • Stollings JL, Diedrich DA, Oyen LJ, Brown DR. Rapid-sequence intubation: a review of the process and considerations when choosing medications. Ann Pharmacother. 2014;48(1):62-76.
  • Sukys GA, Schvartsman C, Reis AG. Evaluation of rapid sequence intubation in the pediatric emergency department. J Pediatr (Rio J). 2011;87(4):343-9.
  • Heschl S, Meadley B, Andrew E, Butt W, Bernard S, Smith K. Efficacy of pre-hospital rapid sequence intubation in paediatric traumatic brain injury: A 9-year observational study. Injury. 2018;49(5):916-20.
  • Kukreti V, Mohseni-Bod H, Drake J. Management of raised intracranial pressure in children with traumatic brain injury. J Pediatr Neurosci. 2014;9(3):207-15.
  • Gerardi MJ, Sacchetti AD, Cantor RM, et al. Rapid-sequence intubation of the pediatric patient. Pediatric Emergency Medicine Committee of the American College of Emergency Physicians. Ann Emerg Med. 1996;28(1):55-74.
  • Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827-48.
  • Schaller SJ, Lewald H. Clinical pharmacology and efficacy of sugammadex in the reversal of neuromuscular blockade. Expert Opin Drug Metab Toxicol. 2016;12(9):1097-108.
  • Jones P, Dauger S, Denjoy I, et al. The effect of atropine on rhythm and conduction disturbances during 322 critical care intubations. Pediatr Crit Care Med. 2013;14(6):e289-97.
  • Fastle RK, Roback MG. Pediatric rapid sequence intubation: incidence of reflex bradycardia and effects of pretreatment with atropine. Pediatr Emerg Care. 2004;20(10):651-5.
  • Pallin DJ, Dwyer RC, Walls RM, Brown CA 3rd; NEAR III Investigators. Techniques and Trends, Success Rates, and Adverse Events in Emergency Department Pediatric Intubations: A Report From the National Emergency Airway Registry. Ann Emerg Med. 2016;67(5):610-615.e1.
  • Oglesby AJ. Should etomidate be the induction agent of choice for rapid sequence intubation in the emergency department?. Emerg Med J. 2004;21(6):655-9.
  • Zuckerbraun NS, Pitetti RD, Herr SM, Roth KR, Gaines BA, King C. Use of etomidate as an induction agent for rapid sequence intubation in a pediatric emergency department. Acad Emerg Med. 2006;13(6):602-9.
  • Tran DT, Newton EK, Mount VA, Lee JS, Wells GA, Perry JJ. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2015;2015(10):CD002788.
  • Bohringer C, Moua H, Liu H. Is There Still a Role for Succinylcholine in Contemporary Clinical Practice?. Transl Perioper Pain Med. 2019;6(4):129-35.
  • Gnauck K, Lungo JB, Scalzo A, Peter J, Nakanishi A. Emergency intubation of the pediatric medical patient: use of anesthetic agents in the emergency department. Ann Emerg Med. 1994;23(6):1242-7.

Rapid sequence intubation experiences in the pediatric emergency department

Year 2023, Volume: 28 Issue: 1, 24 - 29, 20.01.2023
https://doi.org/10.21673/anadoluklin.1137449

Abstract

Aim: Patient selection and management of rapid sequence intubation (RSI) application in the emergency department can be challenging for clinicians. In this study, we aimed to describe the demographic information, clinical characteristics, and medical conditions of the patients who underwent RSI in our hospital’s pediatric emergency department and to present patient management strategies.

Methods: Cases between 1 month to 18 years old who underwent RSI in the emergency department between January 2021 and January 2022 were analyzed retrospectively.

Results: Eleven patients; 7 girls (63,6%) and 4 boys (36,4%) were included in the study. The median age of the patients was 6(2-15) [minimum (min)-maximum (max)]. The median time from symptom onset to presentation was 120 minutes (min-max 15 minutes-2 weeks). RSI indications were trauma (n=5), intracranial mass (n=4), ventriculoperitoneal shunt dysfunction (n=1), and refractory status epilepticus (n=1). All patients had focal neurological deficits on examination. Glasgow Coma Scale median score was 8 (min-max 4-15). The first neuroimaging method was cranial tomography in ten (90.9%) patients. Intracranial hemorrhage was present in 45.4% (5 patients) of the patients. No complications were observed in any of the patients during the RSI application. One patient died due to intracranial hemorrhage and shunt dysfunction. Neurological deficits (dysarthria, gait disturbance, hemiparesis, and visual impairment) were detected in five patients during their first-month follow-up.

Conclusion: This retrospective study identified critically ill children who were admitted to the emergency department with acute neurological symptoms and underwent RSI to prevent increased intracranial pressure and further brain damage.

Supporting Institution

Yoktur

Project Number

Yoktur

Thanks

-

References

  • Bennett BL, Scherzer D, Gold D, et al. Optimizing Rapid Sequence Intubation for Medical and Trauma Patients in the Pediatric Emergency Department. Pediatr Qual Saf. 2020;5(5):e353.
  • Stollings JL, Diedrich DA, Oyen LJ, Brown DR. Rapid-sequence intubation: a review of the process and considerations when choosing medications. Ann Pharmacother. 2014;48(1):62-76.
  • Sukys GA, Schvartsman C, Reis AG. Evaluation of rapid sequence intubation in the pediatric emergency department. J Pediatr (Rio J). 2011;87(4):343-9.
  • Heschl S, Meadley B, Andrew E, Butt W, Bernard S, Smith K. Efficacy of pre-hospital rapid sequence intubation in paediatric traumatic brain injury: A 9-year observational study. Injury. 2018;49(5):916-20.
  • Kukreti V, Mohseni-Bod H, Drake J. Management of raised intracranial pressure in children with traumatic brain injury. J Pediatr Neurosci. 2014;9(3):207-15.
  • Gerardi MJ, Sacchetti AD, Cantor RM, et al. Rapid-sequence intubation of the pediatric patient. Pediatric Emergency Medicine Committee of the American College of Emergency Physicians. Ann Emerg Med. 1996;28(1):55-74.
  • Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015;115(6):827-48.
  • Schaller SJ, Lewald H. Clinical pharmacology and efficacy of sugammadex in the reversal of neuromuscular blockade. Expert Opin Drug Metab Toxicol. 2016;12(9):1097-108.
  • Jones P, Dauger S, Denjoy I, et al. The effect of atropine on rhythm and conduction disturbances during 322 critical care intubations. Pediatr Crit Care Med. 2013;14(6):e289-97.
  • Fastle RK, Roback MG. Pediatric rapid sequence intubation: incidence of reflex bradycardia and effects of pretreatment with atropine. Pediatr Emerg Care. 2004;20(10):651-5.
  • Pallin DJ, Dwyer RC, Walls RM, Brown CA 3rd; NEAR III Investigators. Techniques and Trends, Success Rates, and Adverse Events in Emergency Department Pediatric Intubations: A Report From the National Emergency Airway Registry. Ann Emerg Med. 2016;67(5):610-615.e1.
  • Oglesby AJ. Should etomidate be the induction agent of choice for rapid sequence intubation in the emergency department?. Emerg Med J. 2004;21(6):655-9.
  • Zuckerbraun NS, Pitetti RD, Herr SM, Roth KR, Gaines BA, King C. Use of etomidate as an induction agent for rapid sequence intubation in a pediatric emergency department. Acad Emerg Med. 2006;13(6):602-9.
  • Tran DT, Newton EK, Mount VA, Lee JS, Wells GA, Perry JJ. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2015;2015(10):CD002788.
  • Bohringer C, Moua H, Liu H. Is There Still a Role for Succinylcholine in Contemporary Clinical Practice?. Transl Perioper Pain Med. 2019;6(4):129-35.
  • Gnauck K, Lungo JB, Scalzo A, Peter J, Nakanishi A. Emergency intubation of the pediatric medical patient: use of anesthetic agents in the emergency department. Ann Emerg Med. 1994;23(6):1242-7.
There are 16 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section ORIGINAL ARTICLE
Authors

Raziye Merve Yaradılmış 0000-0003-1202-8564

İlknur Bodur 0000-0002-4135-5700

Muhammed Mustafa Güneylioğlu 0000-0002-9260-6776

Betül Öztürk 0000-0002-8000-3599

Aytaç Göktuğ 0000-0002-0242-2368

Orkun Aydın 0000-0002-3155-540X

Ali Güngör 0000-0003-4139-3480

Can Demir Karacan 0000-0001-5301-8106

Nilden Tuygun 0000-0002-5359-4215

Project Number Yoktur
Publication Date January 20, 2023
Acceptance Date December 20, 2022
Published in Issue Year 2023 Volume: 28 Issue: 1

Cite

Vancouver Yaradılmış RM, Bodur İ, Güneylioğlu MM, Öztürk B, Göktuğ A, Aydın O, Güngör A, Karacan CD, Tuygun N. Rapid sequence intubation experiences in the pediatric emergency department. Anatolian Clin. 2023;28(1):24-9.

13151 This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.