Improving the Safety and Efficacy of Out-of-Hospital Pediatric Airway Management

提高院外儿科气道管理的安全性和有效性

• 批准号: 9355213
• 负责人: Matthew Lee Hansen
• 金额: $ 16.72万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-26 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9355213
• 关键词: Active Learning; Adopted; Adult; Affect; Biometry; Caring; Characteristics; Chest; Child; Childhood; Clinical; Clinical Trials Design; Complex; Consensus; Controlled Environment; Critically ill children; Data; Data Collection; Decision Making; Development Plans; Devices; Education; Emergency Care; Emergency Medicine; Emergency Situation; Emergency research; Environment; Environmental air flow; Epinephrine; Ethnography; Face; Fellowship; Funding; Goals; Gold; Head; Health Sciences; Heart Arrest; Hospitals; Human; Hypercapnia; Hypoxia; Individual; Informed Consent; Intervention; Interview; Intratracheal Intubation; Intubation; Masks; Measures; Medical emergency; Mentors; Modeling; Morbidity - disease rate; National Heart, Lung, and Blood Institute; Observational Study; Operating Rooms; Operative Surgical Procedures; Oregon; Paramedical Personnel; Patients; Pediatric Hospitals; Performance; Pharmaceutical Preparations; Principal Investigator; Procedures; Process; Provider; Pulmonary aspiration of gastric contents; Qualitative Research; Reading; Research; Research Personnel; Research Priority; Research Training; Residencies; Resuscitation; SECTM1 gene; Safety; Science; Structure; Techniques; Testing; Tidal Volume; Time; Training; Training Programs; Trauma; Tube; Universities; Work; career; career development; clinical practice; efficacy study; emergency service responder; endotracheal; experience; improved; innovation; meetings; mortality; novel strategies; pediatric patients; phase III trial; professor; programs; prospective; randomized trial; seal; simulation; skills; success; treatment as usual; trend

Project Summary: I propose a 4-year mentored research training program to become a leader in the field of pediatric emergency care research. I am residency-trained in Emergency Medicine and fellowship-trained in Pediatric Emergency Medicine and am currently Assistant Professor of Emergency Medicine at Oregon Health & Science University. My research focuses on improving safety in the out-of-hospital care of pediatric patients. This proposal focuses specifically on improving the safety of pediatric airway management during out-of-hospital emergencies and studying the efficacy of supraglottic airway devices. My career development plan will provide me advanced skills in decision science, qualitative research, biostatistics, exception from informed consent, and clinical trial design that are critical to advance this field and my career. The training will come through formal coursework, mentored research, experiential learning, focused reading programs, and scientific meetings. The overall objective of this proposal is to test whether supraglottic airway devices are superior to endotracheal intubation and bag-valve-mask ventilation for out-of-hospital pediatric airway management. Endotracheal intubation, a complex and invasive procedure, is the single most common out-of- hospital advanced airway technique and the gold standard in the hospital. However, up to 50% of out-of- hospital pediatric endotracheal intubations are complicated by endotracheal tube misplacement and/or dislodgement, hypoxia, hypercapnia, or damage to airway structures. Bag-valve-mask ventilation is less invasive but challenging in the out-of-hospital environment given the need to provide care in a moving vehicle. There is critical need for a new approach that reduces complications and is effective in oxygenation and ventilation. The central hypothesis of this proposal is to understand whether supraglottic airway devices, commonly used in children in the operating room, are more effective than endotracheal intubation and bag-valve-mask ventilation for out-of-hospital emergency airway management. To test this hypothesis we will 1) examine the efficacy of supraglottic airway devices being used by paramedics in simulation lab and operating room environments; 2) conduct a qualitative study to understand the decision making process used in out-of-hospital pediatric airway management and identify potential barriers to implementation of supraglottic airway devices; and 3) conduct a prospective observational study to determine how the airway management strategy affects CPR quality and medication administration in pediatric out-of- hospital cardiac arrest. This research will help improve out-of-hospital pediatric airway management by helping understand how individual device characteristics, provider factors, and clinical context affect the efficacy and safety of airway management techniques.

项目概要： 我建议一个为期4年的指导研究培训计划，成为儿科急诊领域的领导者 护理研究。我在急诊医学和研究生院实习培训在儿科急诊培训 医学博士，目前是俄勒冈州健康与科学大学急诊医学助理教授。 我的研究重点是提高儿科患者院外护理的安全性。该提案重点 特别是在院外紧急情况下提高儿科气道管理的安全性， 研究声门上通气装置的有效性。我的职业发展计划将为我提供先进的 决策科学、定性研究、生物统计学、知情同意例外和临床试验方面的技能 这些设计对推动这个领域和我的职业生涯至关重要。培训将通过正式的课程进行， 指导性研究、体验式学习、重点阅读项目和科学会议。 本提案的总体目标是测试声门上气道装置是否优于上级 气管内插管和袋-阀-面罩通气用于院外小儿气道 管理气管内插管是一种复杂的侵入性手术，是最常见的非侵入性手术。 医院先进的气道技术和医院的黄金标准。然而，高达50%的... 医院儿科气管内插管由于气管内管错位和/或 移位、缺氧、高碳酸血症或气道结构损伤。袋阀式面罩通气量较少 这是侵入性的，但在医院外的环境中具有挑战性，因为需要在移动的车辆中提供护理。 迫切需要一种新的方法，减少并发症，有效的氧合和 通风.该建议的中心假设是了解声门上气道是否 在手术室中通常用于儿童的装置比气管内更有效 气管插管和袋-阀-面罩通气用于院外紧急气道管理。测试 该假设我们将1）检查护理人员使用的声门上气道装置的有效性， 模拟实验室和手术室环境; 2）进行定性研究以了解决策 制定用于院外儿科气道管理的流程，并识别潜在的障碍， 声门上气道装置的实施;和3）进行前瞻性观察研究，以确定 呼吸道管理策略如何影响心肺复苏质量和儿科外的药物管理， 医院心脏骤停这项研究将有助于改善院外儿科气道管理， 了解个体器械特征、提供者因素和临床背景如何影响疗效， 气道管理技术的安全性。