Raziye Merve YARADILMIŞ, İlknur BODUR, Muhammed Mustafa GÜNEYLİOĞLU, Betül ÖZTÜRK, Aytaç GÖKTUĞ, Orkun AYDIN, Ali GÜNGÖR, Can Demir KARACAN, Nilden TUYGUN

Çocuk acil servisinde hızlı seri entübasyon deneyimlerimiz

Amaç: Acil serviste hasta seçimi ve hızlı seri entübasyon (HSE) uygulamasının yönetimi klinisyenler için zor olabilir. Bu çalışmada hastanemiz çocuk acil servisinde HSE yapılan hastaların demografik ve klinik özelliklerini ile hasta yönetim stratejilerinin değerlendirilmesi amaçlandı.Yöntemler: 1 Ocak 2021 ile 1 Ocak 2022 tarihleri arasında çocuk acil servisinde HSE uygulanan 18 yaşından küçük hastalar çalışmaya dâhil edildi.Bulgular: Çalışmaya 11 hasta dâhil edildi. Hastaların medyan yaşı 6 (2-15) idi [minimum (min)-maksimum (maks)], 7’si kızdı (%63,6). Semptom başlangıcından başvuruya kadar geçen süre medyan değeri 120 dakikaydı (min-maks 15 dakika-2 hafta). HSE endikasyonları travma (n=5), kafa içi kitle (n=4), ventriküloperitoneal şant disfonksiyonu (n=1), dirençli status epileptikus (n=1) idi. Hastaların Glasgow Koma skala skorları ortanca değeri 8 (min-maks 4-15) idi. Hastaların tamamında fokal nörolojik defisit mevcuttu. İlk nörogörüntüleme yöntemi 10 (%90.9) hastada kraniyal tomografiydi ve beş hastada (%45,4) intrakraniyal kanama mevcuttu. HSE’ye bağlı hiçbir hastada komplikasyon izlenmedi. Hastalardan ikisi exitus oldu (intrakraniyal kanama ve şant disfonksiyonu nedeniyle). Birinci ay kontrollerinde beş hastada dizartri, yürüme bozukluğu, hemiparezi, görme bozukluğu gibi nörolojik defisitler tespit edildi.Sonuç: Bu retrospektif çalışma, akut nörolojik semptomlarla acil servise başvuran ve kafa içi basıncının artmasını ve daha fazla beyin hasarını önlemek için HSE uygulanan kritik hasta çocukları tanımladı.

Anahtar Kelimeler:

Çocuklar;, hızlı seri entübasyon, sedasyon

Rapid sequence intubation experiences in the pediatric emergency department

Aim: Patient selection and management of rapid sequence intubation (RSI) application in the emergency department can be challenging for clinicians. In this study, we aimed to describe the demographic information, clinical characteristics, and medical conditions of the patients who underwent RSI in our hospital’s pediatric emergency department and to present patient management strategies.Methods: Cases between 1 month to 18 years old who underwent RSI in the emergency department between January 2021 and January 2022 were analyzed retrospectively.Results: Eleven patients; 7 girls (63,6%) and 4 boys (36,4%) were included in the study. The median age of the patients was 6(2-15) [minimum (min)-maximum (max)]. The median time from symptom onset to presentation was 120 minutes (min-max 15 minutes-2 weeks). RSI indications were trauma (n=5), intracranial mass (n=4), ventriculoperitoneal shunt dysfunction (n=1), and refractory status epilepticus (n=1). All patients had focal neurological deficits on examination. Glasgow Coma Scale median score was 8 (min-max 4-15). The first neuroimaging method was cranial tomography in ten (90.9%) patients. Intracranial hemorrhage was present in 45.4% (5 patients) of the patients. No complications were observed in any of the patients during the RSI application. One patient died due to intracranial hemorrhage and shunt dysfunction. Neurological deficits (dysarthria, gait disturbance, hemiparesis, and visual impairment) were detected in five patients during their first-month follow-up.Conclusion: This retrospective study identified critically ill children who were admitted to the emergency department with acute neurological symptoms and underwent RSI to prevent increased intracranial pressure and further brain damage.

Keywords:

Children, rapid sequence intubation, sedation,

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