Variations in airway management putting children at risk, survey warns

Survey follows 2011 national audit, which recommended changes to paediatric and intensive care practice

Variation in the practice of airway management at intensive care units across the UK is putting babies and children at risk, a survey has warned.

In 2011, the Fourth National Audit Project (NAP4) by the Royal College of Anaesthetists and the Difficult Airway Society reported high rates of airway complications in adult intensive care units, including death or brain injury. The audit recommended preparation for airway difficulty, immediately available difficult airway equipment and routine use of waveform capnography monitoring.

As a follow-up to the audit, a telephone survey of healthcare professionals was conducted between January and October 2016 using a structured questionnaire. Researchers led by the Royal United Hospitals Bath NHS Foundation Trust, analysed 150 responses from senior nursing or medical staff across all UK paediatric intensive care units (PICUs) and 90% of neonatal intensive care units (NICUs).

Carbon dioxide measures

The researchers investigated whether the NAP4 recommendations have been embedded into paediatric and intensive care practice.

Of the 129 NICUs and 27 PICUs who responded to the survey, 34 of the NICUs and five of the PICUs reported death or serious harm in their unit as a result of complications of airway management in the last five years.

A capnograph measures how much carbon dioxide is present in the patient’s breath and helps confirm that the lungs are being adequately ventilated.

More than 80% of UK adult intensive care units have subsequently changed practice.

Protocols for high-risk patients

Only 46% of NICUs have capnography available and it is rarely used, according to the study. Just 40% of NICUs and 67% of PICUs have protocols for high-risk patients.

A total of 78% of PICUs and 34% of NICUs do not formally identify patients with a difficult airway at staff handover.

One of the report authors, Tim Cook, a consultant in anaesthesia and intensive care medicine at the Royal United Hospital Bath NHS Foundation Trust, said: ‘We recommend that lessons from adult ICUs are shared widely with our NICU and PICU colleagues and hope that this survey will prompt discussion about the feasibility of routine capnography monitoring.’

Caroline Lee-Davey, chief executive of the premature and sick baby charity Bliss, said: ‘It is extremely important that the recommendations of this crucial research are taken on board by NHS trusts across the country to ensure that babies on neonatal units receive the highest possible standard of care.’

Related material

• The report led by the Royal United Hospitals Bath NHS Foundation Trust
• The Fourth National Audit Project by the Royal College of Anaesthetists and The Difficult Airway Society (2011)

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