Evaluación de las intubaciones endotraqueales en una unidad de cuidados intensivos pediátricos
- Laura Butragueño-Laiseca
- Laura Torres
- Elena OCampo
- Sara de la Mata Navazo
- Javier Toledano
- Jesús López-Herce
- Santiago Mencía
ISSN: 1695-4033, 1696-4608
Año de publicación: 2023
Volumen: 98
Número: 2
Páginas: 109-118
Tipo: Artículo
Otras publicaciones en: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría ( AEP )
Resumen
Introduction Tracheal intubation is a frequent procedure in paediatric intensive care units that carries a risk of complications that can increase morbidity and mortality. Patients and methods Prospective, longitudinal, observational study in patients intubated in a level iii paediatric intensive care unit between January and December 2020. We analysed the risk factors associated with failed intubation and adverse events. Results The analysis included 48 intubations. The most frequent indication for intubation was hypoxaemic respiratory failure (25%). The first attempt was successful in 60.4% of intubations, without differences between procedures performed by staff physicians and resident physicians (62.5 vs. 56.3%; P = .759). Difficulty in bag-mask ventilation was associated with failed intubation in the first attempt (P = .028). Adverse events occurred in 12.5% of intubations, and severe events in 8.3%, including one case of cardiac arrest, 2 cases of severe hypotension and one of oesophageal intubation with delayed recognition. None of the patients died. Making multiple attempts was significantly associated with adverse events (P < .002). Systematic preparation of the procedure with cognitive aids and role allocation was independently associated with a lower incidence of adverse events. Conclusions In critically ill children, first-attempt intubation failure is common and associated with difficulty in bag-mask ventilation. A significant percentage of intubations may result in serious adverse events. The implementation of intubation protocols could decrease the incidence of adverse events.