Objectives: 

The use and outcomes of nasotracheal intubation in pediatric patients requiring mechanical ventilation have not been quantified. Our goal is to identify prevalence of use, associated factors, and outcomes of nasotracheal versus orotracheal intubation in patients requiring mechanical ventilation.

Design: 

Retrospective cohort study using deidentified data from the Virtual Pediatric Systems database. Data from PICU admissions from January 1, 2015, to December 31, 2016 were analyzed.

Setting: 

One hundred twenty-one PICUs located within the United States.

Patients: 

PICU admissions requiring an endotracheal tube—either nasotracheal or orotracheal—were included. Those with a tracheostomy tube present at admission were excluded from the study.

Interventions: 

Not applicable.

Measurements and Main Results: 

Among the 121 PICUs included in the study, 64 PICUs (53%) had zero nasotracheal intubations during the reviewed time period. There were 12,088 endotracheal intubations analyzed, and 680 of them (5.6%) were nasotracheal. Of those patients nasotracheally intubated, most were under 2 years old (88.1%), and 82.2% of them were classified as a cardiac patient. Among these young cardiac patients, the rate of unplanned extubation was 0% in the nasotracheal intubated versus 2.1% in the orotracheal intubated group (p < 0.001)

Conclusions: 

Nasotracheal intubation is used in a minority of U.S. PICUs and mainly among young cardiac patients. Nasotracheal intubation is associated with a lower rate of unplanned extubations in this patient population. Future prospective studies analyzing the benefits and complications of nasotracheal versus orotracheal intubation in pediatric patients requiring mechanical ventilation are indicated.

中文翻译：

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要求通过美国PICU进行机械通气的患者进行气管插管的使用和结果。

目标： 

在需要机械通气的小儿患者中，鼻气管插管的使用和结局尚未确定。我们的目标是确定需要机械通气的患者的使用率，相关因素以及鼻气管插管与口气管插管的结果。

设计： 

使用来自虚拟儿科系统数据库的不确定数据进行回顾性队列研究。分析了2015年1月1日至2016年12月31日PICU入学的数据。

设置： 

美国境内有一百二十一个PICU。

耐心： 

包括需要气管插管（鼻气管插管或口腔气管插管）的PICU入院。入院时出现气管造口术的患者被排除在研究之外。

干预措施： 

不适用。

测量和主要结果： 

在研究中包括的121个PICU中，有64个PICU（53％）在回顾期间内鼻气管插管为零。分析了1,088例气管插管，其中680例（5.6％）为鼻气管插管。在经气管插管的那些患者中，大多数年龄在2岁以下（88.1％），其中82.2％被归为心脏病患者。在这些年轻的心脏病患者中，气管插管的计划外拔管率为0％，而气管插管组的计划外拔管率为2.1％（p <0.001）

结论： 

鼻气管插管用于少数美国PICU，主要用于年轻的心脏病患者。鼻气管插管与该患者人群中计划外拔管的发生率较低相关。未来的前瞻性研究分析的经鼻气管与好处和并发症经口气管插管在小儿要求患者机械通气表示。