Intubation practices for children in ED and ICU across Australia and New Zealand: A survey of medical staff

Abstract

Background: Intubation of children in the emergency setting is a high risk, low incidence event. Over recent years there has been an effort to improve intubation success in both adults and children through the introduction of intubation checklists and algorithms to focus the team on the task at hand. Despite these check lists, there is still significant variation in clinician practice on the techniques used to optimise conditions for intubation. These variations in practice are largely based on clinician preference, experience and expert opinion without high quality evidence to support one technique over another. Objectives: This study aims to establish a baseline of clinician practice across Australia and New Zealand to inform the design of randomised controlled trials where evidence to support one technique over another is lacking or inadequate. Method: This study was a voluntary questionnaire undertaken by medical staff at registrar level or above in emergency departments and paediatric intensive care units across the PREDICT and ANZICS PSG research networks. Results: A total of 502 clinicians were invited to complete the survey. 336 responses (66.9%) were received over the data collection period. There is marked variation in practice between clinicians in ED and ICU in the techniques used for pre-oxygenation and the frequency of apnoeic oxygenation delivery as well the techniques used. Conclusion: While there is unlikely to be a one-sizefits-all approach to paediatric airway management, there is a paucity of high quality evidence to support clinicians in adopting a best practice approach resulting in a broad variation in practice. In particular, further research is required to investigate the optimal method for preoxygenation, along with the role and optimal technique for delivery of apnoeic oxygenation.L6273925102019-05-14 <br />