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Can critical care transport be safely reduced in children intubated during emergency management of status epilepticus in the United Kingdom: a national audit with case–control analysis
  1. Philip Knight1,2,
  2. Victoria Norman2,
  3. Rochelle Gully3,
  4. Dora Wood3,
  5. Dusan Raffaj4,
  6. Laura Riddick5,
  7. Stephen Hancock5,
  8. Sanjay Revanna6,
  9. Mohammed Uvaise7,
  10. Sasha Herring7,
  11. Mark Worrall8,
  12. Ashley Daye8,
  13. Mark Terris9,
  14. Cormac O'Brien9,
  15. Ananth Kumar2,
  16. Sophie Scott3,
  17. Lisa Pritchard10,
  18. Srinivasan Palaniappan10,
  19. Charlotte Hughes11,
  20. Michael J Griksaitis12,
  21. Shelley Riphagen7,
  22. Padmanabhan Ramnarayan2
  1. 1 Paediatric Intensive Care, King's College London, London, UK
  2. 2 Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Trust, London, UK
  3. 3 Wales and West Acute Transport for Children Service (WATCh), Bristol Royal Hospital for Children, Bristol, UK
  4. 4 Children’s Medical Emergency Transport (COMET), Leicester Royal Infirmary Children's Services, Leicester, UK
  5. 5 Embrace Yorkshire & Humber Infant & Children's Transport Service (Embrace), Sheffield Children's NHS Foundation Trust, Sheffield, UK
  6. 6 Kids Intensive Care and Decision Support and Neonatal Transports Service (KIDSNTS), Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
  7. 7 South Thames Retrieval Service at Evelina London Children's Hospital, Evelina London Children's Healthcare, London, UK
  8. 8 Paediatric Critical Care Transport-ScotSTAR, Royal Hospital for Children, Glasgow, UK
  9. 9 Northern Ireland Specialist Transport and Retrieval (NISTAR), Royal Belfast Hospital for Sick Children, Belfast, UK
  10. 10 Northwest & North Wales Paediatric Transport Service (NWTS), Royal Stoke University Hospital, Stoke-on-Trent, UK
  11. 11 Southampton Oxford Retrieval Team (SORT), Southampton Children's Hospital, Southampton, UK
  12. 12 Paediatric Intensive Care Unit, Southampton Oxford Retrieval Team (SORT), Southampton Children's Hospital, Southampton, UK
  1. Correspondence to Dr Philip Knight, Paediatric Intensive Care, King's College London, London, UK; philip.knight{at}gosh.nhs.uk

Abstract

Objective This study describes the baseline clinical characteristics, predictors of successful extubation at referring hospitals and short-term outcomes of children intubated for status epilepticus and referred to United Kingdom (UK) paediatric critical care transport teams (PCCTs).

Design Multicentre audit with case–control analysis, conducted between 1 September 2018 and 1 September 2020.

Setting This study involved 10 UK PCCTs.

Patients Children over 1 month of age intubated during emergency management for status epilepticus (SE), referred to UK PCCTs. Patients with trauma, requiring time-critical neurosurgical intervention or those with a tracheostomy were excluded.

Interventions No interventions were implemented.

Measurements and main results Out of the 1622 referrals for SE, 1136 (70%) were intubated at referral. The median age was 3 years (IQR 1.25–6.54 years). Among the intubated children, 396 (34.8%) were extubated locally by the referring team, with 19 (4.8%) requiring reintubation. Therefore, the overall rate of successful extubation was 33% (377/1136). There was significant variation between PCCTs, with local extubation rates ranging from 2% to 74%. Multivariable analyses showed region/PCCT, contributing diagnosis, acute changes on CT, preceding encephalopathy and type of continuous sedation (midazolam) used postintubation were significantly associated with transfer to a critical care unit.

Conclusion This study highlights wide regional variation in early extubation practices. Regions with high successful extubation rates have established extubation guidelines from PCCTs. Successful extubation represents critical care transports that have been avoided.

  • Intensive Care Units, Paediatric
  • Paediatric Emergency Medicine
  • Neurology
  • Paediatrics

Data availability statement

Data are available upon reasonable request. Data will be made available on reasonable request.

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Data availability statement

Data are available upon reasonable request. Data will be made available on reasonable request.

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Footnotes

  • X @DrPhilPICU, @MJGriksaitis

  • Contributors Conceptualisation and design—all authors. Data collection—RG, SH, CH, AK, VN, LR, SS and MU. Data analysis and interpretation—PK. Manuscript preparation—PK. Manuscript review and approval—all authors. Thank you to Catherine Rose—contribution to data collection and proforma design.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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