Intubated pediatric patients requiring transport: a review of patients, indications, and standards.
BACKGROUND
We could not find any studies of nontertiary care facilities performing intubation for patients requiring transport to definitive pediatric care. The purpose of our study was to determine the current practices of pediatric airway management in the prehospital and transport environments.


METHODS
A retrospective analysis of all patients younger than 16 years transported by our flight program during a 2-year period served as the population of interest. The flight records (RN and MD documentation) for intubated patients were analyzed for medications, methods, outcomes, and other descriptive endpoints. As a matter of program policy, all pediatric transports are subjected to peer review in the performance improvement committee.


RESULTS
During the review period, 732 patients younger than 16 years (range: 30 days to 15 years) were transported by our flight program. Of the 148 (20%) patients intubated for airway control, 81 were boys (55%), and 67 were girls (45%). Sixteen percent were younger than 1 year, 24% were 1 to 2 years old, 18% were 3 to 5, 20% were 6 to 11, and 22% were 12 to 15. Indicators for intubation included unresponsiveness or arrest, 42 (28%); seizures, 38 (26%); respiratory failure, 28 (19%); decreased level of consciousness (LOC), 14 (9%); airway protection, 13 (9%); combativeness, 11 (7%); and other, 2 (1%). Children were intubated most frequently by the referring physician (92 children, 62% of patients). The flight crew performed 49 (33%) intubations, and EMS staff performed seven (5%). Three children were nasally intubated. Significant variation occurred in medications used, endotracheal tube size and position, and nasogastric decompression. No single group performed better or worse than the others in our review.


CONCLUSIONS
Variability exists in the application of pediatric airway management techniques, including pharmacologic modes and intubation indications.
Nieman
Carolyn T
CT
Division of Trauma, Critical Care, Burns, and Metro Life Flight, Department of Surgery, Case Western Reserve University, Cleveland, Ohio 44109, USA.
Merlino
James I
JI
Kovach
Betty
B
Polk
J D
JD
Mancuso
Charlene
C
Fallon
William F
WF
D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D009820:Ohio; D010043:Outcome and Process Assessment, Health Care; D010372:Pediatrics / Q000592:standards*; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000592:standards*