Pediatric endotracheal intubations for airway management in the emergency department

OBJECTIVE: The objective of this study was to determine indications, type of medications used, and immediate complications of pediatric endotracheal intubations in the emergency department. METHODS: A retrospective chart review was done on all pediatric patients (0-14 years old) who required endotracheal (ET) intubation for airway management in the Department of Emergency Medicine at Aga Khan University Hospital from January to December 2009. Data were collected on a preformed questionnaire for age, sex, indications, drugs used, and complications of pediatric ET intubations done in the emergency department. Dead-on-arrival patients and those intubated elsewhere were excluded. RESULTS: A total of 83 pediatric intubations were done during the study period. Indications for ET intubations were respiratory failure in 51 (61%), unresponsiveness in 18 (22%), cardiac arrest in 8 (10%), and trauma in 6 cases (7%). Comorbid conditions were present in 28 (34%). Of 83 ET intubations, drugs were used in 48 cases (58%). Both sedation and neuromuscular blockade were used in 42 cases (51%), 4 cases (5%) received sedation only, and 2 cases (2%) received relaxation without sedation, and in 35 cases (42%), intubation was done without drugs. Drugs used for sedation/induction were ketamine in 22 (26%), midazolam in 14 (17%), propofol in 7 (8%), and etomidate in 3 cases (4%). Neuromuscular blockades used were rocuronium in 27 cases (32%), succinylcholine in 11 cases (13.5%), and atracurium in 5 cases (6%). Complications were noted in 16 cases (19%). CONCLUSIONS: Respiratory failure was found to be the main presenting complaint. Drugs for sedation and relaxation to facilitate ET intubation were underused.