ABSTRACT 831

Abstract

Background and aims: PICANet (2009–2011) shows children <2 years account for majority PICU admissions (59%; 32643), with 48.1 % <1year. Centralisation of paediatric services, means that Anaesthetists/Paediatricians in District General Hospitals (DGHs) are decreasingly exposed to <2 years, yet must remain prepared to stabilise critically ill children. Regional Retrieval Teams (RRTs) transfer critically ill children from DGHs to Paedatric Intensive Care Units (PICUs). Aims: To identify: Numbers of children <1yr and <2yr referred to RRT; DGH airway management; RRT role in DGH Airway management Methods: Retrospective audit (01.12.2011–30.11.2012): children <2yr intubated at DGHs and transferred by RRT. Results: 145/196 (74%) intubations <1yr, and 51(26.0%)1-2yrs. 142(97.9%) of <1yrs and 47(92.2%)<2yrs transferred by RRT. Approximately 50% of all <2yrs intubated by local anaesthetists, and 10% by RRT. 30% of <1yrs intubated by paediatric teams, compared to 5% of 1-2yrs. 4(2.8%) intubations by neonatal teams, 1(2.0%) by ENT consultant. 3/5 laryngoscopy grades >3 were known difficult intubations. Gas inductions and airway adjuncts documented in 6 cases, including Glidescope, and Hopkin’s Rod. RRT facilitated Anaesthetic/ENT support in 10 cases. Most common complication was hypotension in <1yrs, and ETT leak in <2yrs. Most significant complication was hypoxic cardiac arrest in all <2yrs. Other complications include multiple intubation attempts, local team(s) unable to secure airway. Conclusions: Intubation of critically ill <2yrs remains a high risk, high skill procedure. RRTs play key role facilitating communication between Anaesthetic/ENT teams for known difficult airway management. Scope for development of difficult airway alerts/management guideline, which could be centralised through the RRT team.