Stabilisation of critically ill children at the district general hospital prior to intensive care retrieval: a snapshot of current practice

Lampariello, S.; Clement, M.; Aralihond, A. P.; Lutman, D.; Montgomery, M. A.; Petros, A. J.; Ramnarayan, P.
September 2010
Archives of Disease in Childhood -- Fetal & Neonatal Edition;Sep2010, Vol. 95 Issue 9, p6
Academic Journal
Objective To describe current practice during stabilisation of children presenting with critical illness to the district general hospital (DGH), preceding retrieval to intensive care. Design Observational study using prospectively collected transport data. Setting A centralised intensive care retrieval service in England and referring DGHs. Patients Emergency transports to intensive care during 2-month epochs from 4 consecutive years (2005-2008). Interventions None. Main outcome measures Proportion of key airway, breathing, and circulatory and neurological stabilisation procedures, such as endotracheal intubation, mechanical ventilation, vascular access, and initiation of inotropic agents, performed by referring hospital staff prior to the arrival of the retrieval team. Results 706 emergency retrievals were examined over a 4-year period. The median age of transported children was 10 months (IQR, 18 days to 43 months). DGH staff performed the majority of endotracheal intubations (93.7%, CI 91.3% to 95.5%), initiated mechanical ventilation in 76.9% of cases (CI 73.0% to 80.4%), inserted central venous catheters frequently (67.4%, CI 61.7% to 72.6%), and initiated inotropic agents in 43.7% (CI 36.6% to 51.1%). The retrieval team was more likely to perform interventions such as reintubation for air leak, repositioning of misplaced tracheal tubes, and administration of osmotic agents for raised intracranial pressure. The performance of one or more interventions by the retrieval team was associated with severity of illness, rather than patient age, diagnostic group, or team response time (OR 3.62, 95% CI 1.47 to 8.92). Conclusions DGH staff appropriately performs the majority of initial stabilisation procedures in critically ill children prior to retrieval. This practice has not changed significantly for the past 4 years, attesting to the crucial role played by district hospital staff in a centralised model of paediatric intensive care.


Related Articles

  • Pediatric cuffed endotracheal tubes. Bhardwaj, Neerja // Journal of Anaesthesiology Clinical Pharmacology;Jan2013, Vol. 29 Issue 1, p13 

    Endotracheal intubation in children is usually performed utilizing uncuffed endotracheal tubes for conduct of anesthesia as well as for prolonged ventilation in critical care units. However, uncuffed tubes may require multiple changes to avoid excessive air leak, with subsequent environmental...

  • Tracheal Laceration Due to Elective Intubation and Its Treatment with Endotracheal Stenting. Kekeçoğlu, Aybüke; Özdemir, Cengiz; Karasulu, Levent; Koşar, Ayşe Filiz; Dalar, Levent // Eurasian Journal of Pulmonology;Aug2015, Vol. 17 Issue 2, p119 

    Tracheal laceration as a result of elective intubation is a rarely seen complication with a high mortality. An eighty-one years old, female patient who was followed in the intensive care unit and treated with mechanical ventilation, developed subcutaneous emphysema after intubation. Fiberoptic...

  • Variables affecting leakage past endotracheal tube cuffs: a bench study. Pitts, Renée; Fisher, Daniel; Sulemanji, Demet; Kratohvil, Joseph; Jiang, Yandong; Kacmarek, Robert // Intensive Care Medicine;Dec2010, Vol. 36 Issue 12, p2066 

    Purpose: Leakage of oral secretions past endotracheal tubes (ETT) has been implicated in ventilator associated pneumonia. The aim of this bench study was to compare the ability of current generation ETT cuffs to prevent fluid leakage and to determine the specific mechanical ventilator settings...

  • Prevention of Endotracheal Tube Biofilm Formation in Intubated Critically Ill Patients. Berra, Lorenzo; Kumar, Asheesh // Current Respiratory Medicine Reviews;2010, Vol. 6 Issue 1, p3 

    Endotracheal tubes (ETT) of intubated patients are constantly challenged with abundant bacteria-laden secretions. Quickly those bacteria may organize in a well-organized structure (biofilm) which is difficult to eradicate. Fragments can detach spontaneously or become dislodged by suction...

  • Teaching and training in ibreoptic bronchoscope-guided endotracheal intubation. US, Raveendra // Indian Journal of Anaesthesia;Sep/Oct2011, Vol. 55 Issue 5, p451 

    Fibreoptic-guided endotracheal intubation skill is a strongly desirable attribute of an anaesthesiologist, essential to deal with dificult airway situations. Facilities for formal training in this crucial area are limited. Various aspects of the available and desirable training in ibreoptic...

  • Avoidance of endobronchial intubation: Measuring the depth of endotracheal tube insertion is simple and effective. O'Connor, Christopher J. // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;11/27/2010, Vol. 341 Issue 7783, p1111 

    The author comments on the study "Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscuitation, or observation of chest movements: randomized trial," by C. Sitzwohl and colleagues, published within the issue. A review of the related literature on...

  • Some Comments On the Cuff. Hurford, William E. // Respiratory Care;Oct2011, Vol. 56 Issue 10, p1625 

    In this article, the author discusses the study of W. R. Howard on maintaining a stable artificial airway pressure within endotracheal tube (ETT) cuff. The author mentions the device designed by Howard which measures and maintains the pressure of the ETT cuff within specified range. He states...

  • Effect of tracheostomy on pulmonary mechanics: An observational study. Sofi, Khalid; Wani, Tariq // Saudi Journal of Anaesthesia;Jan2010, Vol. 4 Issue 1, p2 

    Background: This study was undertaken to find out the effect of early tracheostomy on weaning from mechanical ventilation. Pulmonary mechanics and arterial blood gases were assessed before and after tracheostomy in patients with severe head injury (Glasgow coma score < 8) requiring prolonged...

  • Comparison of the Pentax Airway Scope and McGrath Videolaryngoscope with the Macintosh laryngoscope in tracheal intubation by anaesthetists unfamiliar with videolaryngoscopes: a manikin study. SHARMA, D.-J.; WEIGHTMAN, W. M.; TRAVIS, A. // Anaesthesia & Intensive Care;Jan2010, Vol. 38 Issue 1, p39 

    The article discusses a study on tracheal intubation using the Macintosh laryngoscope (Mac), Pentax Airway Scope (AWS) and the McGrath Videolaryngoscope (MVL) in a manikin model performed by anaesthetists without experience in the use of the videoscopes in Perth, Western Australia. Twenty...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics