MANAGEMENT OF CHILDREN WITH EPIGLOTTITIS DURING TRANSPORT - ANALYSIS OF A SURVEY

Because nationally accepted guidelines for the management of children with epiglottitis during transport have not been published, we surveye d physicians attending the 1990 Pediatric Critical Care Transport Lead ership Conference in order to delineate current practices and to test for correlations between complications and methods of management. A 22 -item questionnaire was distributed, addressing demographics, availabi lity and composition of a designated transport team, methods of airway management, use of medications for sedation or paralysis, monitoring techniques, and complications encountered during transport. Forty-thre e of the 49 attendees completed the questionnaire (87.8%). Almost all were attending physicians (60.9% pediatric intensivists, 29.3% pediatr ic emergency physicians) practicing in tertiary care facilities (58.5% in children's hospitals, 41.5% in general hospitals). Eighty-three pe rcent of centers had designated transport teams. For transfer of a chi ld with suspected epiglottitis from a physician's office, virtually al l respondents recommended transport by ambulance, 64% to the nearest f acility and 36% directly to a tertiary care center. Regarding interhos pital transfers, 49% recommended intubation prior to transport in all cases, whereas 49% considered it on an individual basis. The majority of respondents preferred nasal intubation. To prevent dislocation of t he endotracheal tube, 79.1% recommended taping it to the face only (as opposed to around the skull), 70.7% administered paralytic agents, bu t only 35.2% used additional mechanical restraints. Thirty-seven perce nt reported complications during transport. When groups with and witho ut transport teams were compared, significantly fewer groups with team s reported complications. Reports of accidental extubation did not dif fer significantly between those groups that recommended the use of par alytic agents and those that did not, or between those that used mecha nical restraints and those that did not. In summary, there was no univ ersally accepted protocol for transporting a patient with epiglottitis . Our data did suggest, however, that using a trained transport team m ay reduce the risk of complications.