Abstract P-133: SHOULD PAEDIATRIC INTENSIVE CARE RETRIEVAL UNITS PLAY A BIGGER ROLE IN HELPING DISTRICT GENERAL HOSPITALS IN THE ACUTE MANAGEMENT OF DIFFICULT AIRWAYS? A CASE SERIES.

Abstract

Aims & Objectives: The North West and North Wales Paediatric Transport Service (NWTS) is a specialist paediatric critical care unit covering a total of 31 District General Hospitals (DGH). We describe 10 cases referred to NWTS from regional emergency departments that highlight NWTS role in providing support, and how the difficult airway guideline helps in anticipating problems when managing challenging paediatric airways. Methods Difficult airway is the clinical situation in which clinicians experience difficulties with bag mask ventilation (BMV), tracheal intubation, or both (can’t intubate, can’t ventilate (CICV)) • 0.42% of elective paediatric intubations. • 0.02% for BMV • 1/10-50,000 for CICV adults. (Likely to be significantly higher during emergency paediatric intubations) NWTS data revealed: • 11.2% incidence of grade 2 or above laryngoscopy (357 intubations of critically sick 1–5 year olds) • 21% complication risk in age <2 (hypotension or hypoxia) Results Centralisation of children’s services in the UK has led to decreased exposure of DGH staff to paediatric airway management. Regional retrieval teams such as NWTS provide support and have proposed a regional difficult paediatric airway intubation guideline as the Difficult Airway Society guidelines exclude children under the age of 1. The guideline underlines the importance of alternative plans required to ensure a successful outcome. Equipment and monitoring should be standardised across all hospital departments. Education and regular training in airway management reduces the risk in difficult intubations. Conclusions The case series highlight that regional paediatric critical care retrieval units have an emerging role in the advice and management of paediatric challenging airway cases of critically ill children.