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Abstract：
OBJECTIVE: This study aimed to characterize medication-related practices during and immediately -following rapid sequence intubation (RSI) in pediatric care units across the United States and to evaluate adverse drug events.
METHODS: This was a multicenter, observational study of medication practices surrounding intubation in pediatric and neonatal intensive care unit (NICU) and emergency department patients across the United States.
RESULTS: A total of 172 patients from 13 geographically diverse institutions were included. Overall, 24%, 69%, and 50% received preinduction, induction, and neuromuscular blockade, respectively. Induction and neuromuscular blocking agent (NMBA) use was low in NICU patients (52% and 23%, respectively), whereas nearly all patients intubated outside of the NICU received both (98% and 95%, respectively). NICU patients who received RSI medications were older and weighed more. Despite infrequent use of atropine (21%), only 3 patients developed bradycardia after RSI. Of the 119 patients who received an induction agent, fentanyl (67%) and midazolam (34%) were administered most frequently. Hypotension and hypertension occurred in 23% and 24% of patients, respectively, but were not associated with a single induction agent. Etomidate use was low and not associated with development of adrenal insufficiency. Rocuronium was the most used NMBA (78%). Succinylcholine use was low (11%) and administered despite hyperkalemia in 2 patients. Postintubation sedation and analgesia were not used or inadequate based on timing of initiation in many patients who received a non-depolarizing NMBA.
CONCLUSIONS: Medication practices surrounding pediatric RSI vary across the United States and may be influenced by patient location, age, and weight.
METHODS: This was a multicenter, observational study of medication practices surrounding intubation in pediatric and neonatal intensive care unit (NICU) and emergency department patients across the United States.
RESULTS: A total of 172 patients from 13 geographically diverse institutions were included. Overall, 24%, 69%, and 50% received preinduction, induction, and neuromuscular blockade, respectively. Induction and neuromuscular blocking agent (NMBA) use was low in NICU patients (52% and 23%, respectively), whereas nearly all patients intubated outside of the NICU received both (98% and 95%, respectively). NICU patients who received RSI medications were older and weighed more. Despite infrequent use of atropine (21%), only 3 patients developed bradycardia after RSI. Of the 119 patients who received an induction agent, fentanyl (67%) and midazolam (34%) were administered most frequently. Hypotension and hypertension occurred in 23% and 24% of patients, respectively, but were not associated with a single induction agent. Etomidate use was low and not associated with development of adrenal insufficiency. Rocuronium was the most used NMBA (78%). Succinylcholine use was low (11%) and administered despite hyperkalemia in 2 patients. Postintubation sedation and analgesia were not used or inadequate based on timing of initiation in many patients who received a non-depolarizing NMBA.
CONCLUSIONS: Medication practices surrounding pediatric RSI vary across the United States and may be influenced by patient location, age, and weight.
摘要：
目的：本研究旨在描述美国儿科护理单位在快速序列插管（RSI）期间和之后的药物相关实践，并评估药物不良事件。
方法：这是一个多中心，在美国儿科和新生儿重症监护病房（NICU）和急诊科患者中，围绕插管的用药实践的观察性研究。
结果：共纳入了来自13个地理不同机构的172名患者。总的来说,24%,69%,50%接受了预诱导，归纳法,和神经肌肉阻滞，分别。NICU患者的诱导和神经肌肉阻滞剂(NMBA)使用率较低(52%和23%,分别)，而几乎所有在NICU外插管的患者都接受了这两种治疗（98％和95％，分别)。接受RSI药物治疗的NICU患者年龄较大，体重较重。尽管很少使用阿托品（21％），只有3例患者在RSI后出现心动过缓.在接受诱导剂的119名患者中，芬太尼(67%)和咪达唑仑(34%)的给药频率最高.23％和24％的患者发生低血压和高血压，分别,但与单一诱导剂无关。依托咪酯的使用率较低，与肾上腺功能不全的发展无关。罗库溴铵是使用最多的NMBA（78％）。尽管有2例患者出现高钾血症，但琥珀酰胆碱的使用量较低（11％）。许多接受非去极化NMBA的患者未使用插管后镇静和镇痛或不充分。
结论：围绕小儿RSI的用药实践在美国各地各不相同，可能受患者位置的影响，年龄,和重量。
方法：这是一个多中心，在美国儿科和新生儿重症监护病房（NICU）和急诊科患者中，围绕插管的用药实践的观察性研究。
结果：共纳入了来自13个地理不同机构的172名患者。总的来说,24%,69%,50%接受了预诱导，归纳法,和神经肌肉阻滞，分别。NICU患者的诱导和神经肌肉阻滞剂(NMBA)使用率较低(52%和23%,分别)，而几乎所有在NICU外插管的患者都接受了这两种治疗（98％和95％，分别)。接受RSI药物治疗的NICU患者年龄较大，体重较重。尽管很少使用阿托品（21％），只有3例患者在RSI后出现心动过缓.在接受诱导剂的119名患者中，芬太尼(67%)和咪达唑仑(34%)的给药频率最高.23％和24％的患者发生低血压和高血压，分别,但与单一诱导剂无关。依托咪酯的使用率较低，与肾上腺功能不全的发展无关。罗库溴铵是使用最多的NMBA（78％）。尽管有2例患者出现高钾血症，但琥珀酰胆碱的使用量较低（11％）。许多接受非去极化NMBA的患者未使用插管后镇静和镇痛或不充分。
结论：围绕小儿RSI的用药实践在美国各地各不相同，可能受患者位置的影响，年龄,和重量。
