Emergency intubation of the pediatric medical patient: use of anesthetic agents in the emergency department.

Study Objectives: To delineate the diagnoses of children who required emergency intubation, to ascertain which medications were used, and to describe the complications of intubation and their association with the choice of medications. DESIGN, SETTING, AND TYPE OF PARTICIPANTS: Three-year retrospective study of 60 intubations of critically ill pediatric patients by pediatric emergency physicians in the emergency department setting.

Measurements And Main Results: Clinical complications were noted for intubations with neuromuscular paralysis and intubations initially attempted without a paralyzing agent. Intubations attempted without neuromuscular paralysis resulted in a higher rate of complications (53% versus 26%) and a greater risk of more than one complication per intubation. This finding appeared to be independent of physicians' clinical experience.

Conclusion: Rapid-sequence protocols with paralysis facilitate intubations in the complex pediatric patient in the ED setting.