Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma : a descriptive study

Show full item record



Permalink

http://hdl.handle.net/10138/283167

Citation

Simons , T , Soderlund , T & Handolin , L 2017 , ' Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma : a descriptive study ' , European Journal of Trauma and Emergency Surgery , vol. 43 , no. 6 , pp. 797-804 . https://doi.org/10.1007/s00068-016-0758-2

Title: Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma : a descriptive study
Author: Simons, T.; Soderlund, T.; Handolin, L.
Contributor: University of Helsinki, Clinicum
University of Helsinki, I kirurgian klinikka (Töölö)
University of Helsinki, I kirurgian klinikka (Töölö)
Date: 2017-12
Language: eng
Number of pages: 8
Belongs to series: European Journal of Trauma and Emergency Surgery
ISSN: 1863-9933
URI: http://hdl.handle.net/10138/283167
Abstract: Purpose Pediatric prehospital endotracheal intubation (PHETI) is a difficult and rarely performed procedure that remains the gold standard for prehospital airway management when ventilation and/or anesthesia is required, but high complications rates, including malposition continue to concern. We reviewed the experience in our institution of pediatric intubations with particular emphasis on the position of the endotracheal tube (ETT) tip within the trachea and related complications. Method Intubated pediatric patients presenting directly from the scene to our level 1 trauma center, between 2006 and 2014, were included in our study. Patient records and radiographs were retrospectively reviewed to identify the ETT tip-to-carina distance and possible intubation-related complications. ETT tips identified beyond the carina on radiographs or by clinical diagnosis were defined as misplaced. Because head movement causes a significant ETT movement within the trachea, which is age related, we also defined ETT tip placement (1) less than 2 cm above the carina in children younger than 8 and (2) less than 3 cm above the carina in children 8 years or older as "near miss" intubations. Results From a total of 34 cases, ETT misplacement was identified in seven cases. Diagnosis was made radiologically in five cases and clinically in two cases. Four of these patients had left lung atelectasis due to tube misplacement. Tube thoracotomy was performed in two of these patients without concurrent evidence of chest injury. "Near miss" intubations accounted for 7/9 and 9/25 in children <8 years and >= 8 years old, respectively, totaling 16/34, with two of these leading to late displacements. Conclusions Pediatric endotracheal tube intubation carries a high rate of tube malposition and left lung atelectasis in our experience of pediatric trauma patients, with less than a third of ETTs placed in a safe position.
Subject: Pediatric intubation
Pediatric prehospital endotracheal intubation
Safe zone
Tip-to-carina distance
Near miss intubation
Complication
INJURY SEVERITY SCORE
AIRWAY MANAGEMENT
TRACHEAL TUBE
TIP POSITION
CHILDREN
DISPLACEMENT
CUFF
3126 Surgery, anesthesiology, intensive care, radiology
Rights:


Files in this item

Total number of downloads: Loading...

Files Size Format View
10.1007_s00068_016_0758_2.pdf 853.3Kb PDF View/Open

This item appears in the following Collection(s)

Show full item record