Factors Associated with the Underuse of Sedatives and Neuromuscular Blocking Agents for Pediatric Emergency Endotracheal Intubation in Korea
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Purpose: Rapid sequence intubation (RSI) using sedatives and neuromuscular blocking agents (NMBAs) is recommended forpediatric emergency endotracheal intubation (ETI), but is not frequently performed in Korea. This study aimed to verify factorsassociated with the underuse of RSI medications. Materials and Methods: This multicenter retrospective study reviewed patients aged under 18 years who underwent an ETI with in 24 hours of arrival at the emergency department between 2016 and 2019. Any cases of ETI during cardiopulmonary resuscita tion were excluded. We investigated the characteristics of the patients, intubators, RSI medications, and outcomes. The study caseswere classified into no-medication, sedative-only, and sedative-with-NMBA groups. Multivariable logistic regression analysis of RSImedication use was conducted. Results: A total of 334 cases with a median age of 3.4 years were included in this study. Sedatives and NMBAs were used in 63.8%and 32.9%, respectively. In comparing the no-medication (n=121), sedative-only (n=103), and sedative-with-NMBA (n=110) groups,patient age (median; 1.0 year vs. 2.8 years vs. 11.3 years; p<0.001), underlying medical conditions (77.7% vs. 56.3% vs. 36.4%;p<0.001), and pediatricians as intubators (76.9% vs. 54.4% vs. 17.3%; p<0.001) were different. The factors that influenced sedativeswith NMBA use were patient age [for a year increment; adjusted odds ratio (aOR), 1.182; 95% confidence interval (CI), 1.120–1.249], no underlying medical conditions (aOR, 2.109; 95% CI, 1.093–4.070), and intubators other than pediatricians (aOR, 5.123;95% CI, 2.257–11.626). Conclusion: RSI accounted for 32.9% of pediatric emergency ETI in Korea. The underuse of RSI medications is associated withyounger patient age, underlying medical conditions, and pediatricians as intubators.
Abstract
Purpose: Rapid sequence intubation (RSI) using sedatives and neuromuscular blocking agents (NMBAs) is recommended forpediatric emergency endotracheal intubation (ETI), but is not frequently performed in Korea. This study aimed to verify factorsassociated with the underuse of RSI medications. Materials and Methods: This multicenter retrospective study reviewed patients aged under 18 years who underwent an ETI with in 24 hours of arrival at the emergency department between 2016 and 2019. Any cases of ETI during cardiopulmonary resuscita tion were excluded. We investigated the characteristics of the patients, intubators, RSI medications, and outcomes. The study caseswere classified into no-medication, sedative-only, and sedative-with-NMBA groups. Multivariable logistic regression analysis of RSImedication use was conducted. Results: A total of 334 cases with a median age of 3.4 years were included in this study. Sedatives and NMBAs were used in 63.8%and 32.9%, respectively. In comparing the no-medication (n=121), sedative-only (n=103), and sedative-with-NMBA (n=110) groups,patient age (median; 1.0 year vs. 2.8 years vs. 11.3 years; p<0.001), underlying medical conditions (77.7% vs. 56.3% vs. 36.4%;p<0.001), and pediatricians as intubators (76.9% vs. 54.4% vs. 17.3%; p<0.001) were different. The factors that influenced sedativeswith NMBA use were patient age [for a year increment; adjusted odds ratio (aOR), 1.182; 95% confidence interval (CI), 1.120–1.249], no underlying medical conditions (aOR, 2.109; 95% CI, 1.093–4.070), and intubators other than pediatricians (aOR, 5.123;95% CI, 2.257–11.626). Conclusion: RSI accounted for 32.9% of pediatric emergency ETI in Korea. The underuse of RSI medications is associated withyounger patient age, underlying medical conditions, and pediatricians as intubators.
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