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Protocol for Rapid Sequence Intubation in Pediatric Patients - a Four-Year Study

Eduardo Marvez-Valls, James Killeen, Steven J Weiss, Amy A Ernst, Debra Houry

Med Sci Monit 2002; 8(4): CR229-234

ID: 420876

BACKGROUND: To evaluate a protocol for rapid sequence intubation (RSI)for pediatric patients in a Level 1 trauma center. MATERIAL/METHODS: Retrospective review of prospectivelygathered Continuing Quality Improvement (CQI) data at an inner city Level 1 trauma center with an emergencymedicine residency program. Protocols for RSI were established prior to initiating the study. All pediatricintubations at the center from February 1996 to February 2000 were included. Statistical analysis includeddescriptive statistics for categorical data and Chi-square for comparisons between groups. RESULTS: Overthe 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.

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