Because nationally accepted guidelines for the management of children with epiglottitis during transport have not been published, we surveyed physicians attending the 1990 Pediatric Critical Care Transport Leadership Conference in order to delineate current practices and to test for correlations between complications and methods of management. A 22-item questionnaire was distributed, addressing demographics, availability and composition of a designated transport team, methods of airway management, use of medications for sedation or paralysis, monitoring techniques, and complications encountered during transport. Forty-three of the 49 attendees completed the questionnaire (87.8%). Almost all were attending physicians (60.9% pediatric intensivists, 29.3% pediatric emergency physicians) practicing in tertiary care facilities (58.5% in children’s hospitals, 41.5% in general hospitals). Eighty-three percent of centers had designated transport teams. For transfer of a child with suspected epiglottitis from a physician’s office, virtually all respondents recommended transport by ambulance, 64% to the nearest facility and 36% directly to a tertiary care center. Regarding interhospital transfers, 49% recommended intubation prior to transport in all cases, whereas 49% considered it on an individual basis. The majority of respondents preferred nasal intubation. To prevent dislocation of the endotracheal tube, 79.1% recommended taping it to the face only (as opposed to around the skull), 70.7% administered paralytic agents, but only 35.2% used additional mechanical restraints. Thirty-seven percent reported complications during transport. When groups with and without transport teams were compared, significantly fewer groups with teams reported complications. Reports of accidental extubation did not differ significantly between those groups that recommended the use of paralytic agents and those that did not, or between those that used mechanical restraints and those that did not. In summary, there was no universally accepted protocol for transporting a patient with epiglottitis. Our data did suggest, however, that using a trained transport team may reduce the risk of complications.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Emergency Medicine