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Seizing the opportunity to extubate locally?
  1. JG McViety,
  2. L Jackman,
  3. R Barber,
  4. K Parkins
  1. North West and North Wales Paediatric Transport Service, NWTS, Warrington, UK

Abstract

Aims Previous audits have demonstrated a significant number of children are extubated shortly following paediatric intensive care unit (PICU) admission, especially those with status epilepticus (CSE).1-3 It may be that a subgroup of patients could be safely extubated at their district general hospital (DGH), avoiding inter-hospital transfer, with potential benefits for patients, families and resource utilisation.

Our objectives were to:

  • (1) Determine proportions and characteristics of children referred to a regional paediatric retrieval service (RS) with CSE, including those extubated at their DGH.

  • (2) Compare morbidity associated with extubation in the DGH and PICU settings.

  • (3) Determine compliance with management guidelines.

Methods Retrospective audit of children, referred to RS with CSE 1/11/2010-31/8/2011. Clinical and demographic data were obtained from RS logs and PICU records.

Patients Excluded: <1 month or <37/40; those with tracheostomies; intracranial tumours; trauma or neurosurgical emergencies.

Standards: Regional management guideline for paediatric CSE.

Results 73/91 children met inclusion criteria; median age 20 months. 58/73 patients were intubated.

38/58 (65.5%) were extubated ≤24 hrs. 11/58 (19%) were extubated locally with no reported morbidity or reintubations; two extubated by RS (table 1). In eight patients, local extubation was discussed but not undertaken (table 2). One transferred to adult ICU. 46/58 transferred to PICU; 27/46 (58.7%) were extubated ≤24 hours of intubation; only one failed extubation. Pharmacological guidelines not followed for 22/73; eight received >two benzodiazepine doses.

Abstract G299 Table 1

Characteristics and outcome of children extubated locally compared with those transferred to PICU

Abstract G299 Table 2

Reasons why patients extubated locally where considered (n=8)

Conclusions Our data confirm that a significant number of children with CSE extubate ≤24 hours of intubation and suggest a proportion can be successfully and safely extubated at their DGH. Excessive benzodiazepine use may be a modifiable risk factor for intubation. Prospective studies are merited to further delineate morbidity associated with, and resource implications of local extubation.

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