Evaluation of rapid sequence intubation in the pediatric emergency department

Objectives: To describe the experience of the emergency department of a pediatric hospital with rapid sequence intubation (RSI) and to identify the factors associated with successful intubation. Methods: This prospective, observational, cross-sectional study conducted from July 2005 to December 2007 consisted of collection of data regarding tracheal intubations performed at the emergency department of Instituto da Crianca of Hospital das Clinicas, School of Medicine, Universidade de Sao Paulo. Successful tracheal intubations were the ones performed at the first attempt. Results: One-hundred and seventeen tracheal intubations were performed; 80% of them were RSIs; 79% of patients had underlying diseases; acute respiratory failure was the cause of tracheal intubation in 40%; success rate was 39%; second-year pediatric resident physicians were responsible for 74% of tracheal intubations; positive pressure ventilation was performed in 74% of procedures, with less frequent use among patients who were successfully intubated (p = 0.002). Midazolam was the sedative used in 80% of procedures, and rocuronium was the neuromuscular blocker in 100%; complications of RSI were described in 80% of intubations, with decreased oxygen saturation being reported in 47% and lower decrease in those patients successfully intubated (p < 0.001); difficulties related to tracheal intubation were less frequent in the successful procedures (p < 0.001). Conclusion: RSI is the method of choice for tracheal intubations performed in the emergency department (80%). In spite of the low success rate (39%) in the present study, RSI has proven to be a safe method, with a low incidence of severe complications. The success of tracheal intubation using RSI seems to be directly related to the preparation of the procedure and the health professional's experience. Thus, we conclude that further training of resident physicians and health professionals working in the emergency department is required.