Protocol for rapid sequence intubation in pediatric patients -- a four-year study.
BACKGROUND
To evaluate a protocol for rapid sequence intubation (RSI) for pediatric patients in a Level 1 trauma center.


METHODS
Retrospective review of prospectively gathered Continuing Quality Improvement (CQI) data at an inner city Level 1 trauma center with an emergency medicine residency program. Protocols for RSI were established prior to initiating the study. All pediatric intubations at the center from February 1996 to February 2000 were included. Statistical analysis included descriptive statistics for categorical data and Chi-square for comparisons between groups.


RESULTS
Over the 4-year study period there were 83 pediatric intubations ranging in age from 18 months to 17 years; mean age 8.6. All had data collected at the time of intubation. There were 20 (24%) females and 62 (76%) males (p<0.001). Reasons for intubation were related to trauma in 71 (86%) and medical reasons in 12 (14%) (p<0.001). Of the trauma intubations 7 (10%) were for gunshot wounds, 39 (55%) were secondary to MVCs, and the remainder (25; 35%) were from assaults, falls, and closed head injuries. The non-trauma intubations were for smoke inhalation, overdose, seizure, HIV related complications, eclampsia, and near drowning. Intubations were successful with one attempt in 65 (78%) cases. No surgical airways were necessary. Rocuronium was used in 4 cases. Protocol deviations did not lead to complications.


CONCLUSIONS
This protocol based pediatric rapid sequence intubation method worked well in an EM residency program. More intubations were in males and more were necessary due to trauma in this group.
Marvez-Valls
Eduardo
E
Medical Center of New Orleans Section of Emergency Medicine, New Orleans, Louisiana, USA.
Houry
Debra
D
Ernst
Amy A
AA
Weiss
Steven J
SJ
Killeen
James
J
D000293:Adolescent; D000732:Androstanols / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003953:Diagnosis-Related Groups; D004334:Drug Administration Schedule; D004630:Emergencies / Q000453:epidemiology; D004638:Emergency Treatment / Q000379:methods* / Q000706:statistics & numerical data; D005045:Etomidate / Q000008:administration & dosage; D005260:Female; D005568:Forms and Records Control; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods* / Q000706:statistics & numerical data; D008012:Lidocaine / Q000008:administration & dosage; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D012189:Retrospective Studies; D000077123:Rocuronium; D013390:Succinylcholine / Q000008:administration & dosage; D013874:Thiopental / Q000008:administration & dosage; D014193:Trauma Centers / Q000706:statistics & numerical data*
D000732:Androstanols; D006993:Hypnotics and Sedatives; D003473:Neuromuscular Nondepolarizing Agents; D001285:Atropine; D008012:Lidocaine; D013390:Succinylcholine; D013874:Thiopental; D000077123:Rocuronium; D005045:Etomidate