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ABSTRACT 952

MANAGEMENT OF CHILDREN REFERRED TO THE NORTH WEST AND NORTH WALES PAEDIATRIC TRANSPORT SERVICE (NWTS) WITH STATUS EPILEPTICUS

Messahel, S.1; Phatak, R.2; Barber, R.2

Pediatric Critical Care Medicine: May 2014 - Volume 15 - Issue 4_suppl - p 210–211
doi: 10.1097/01.pcc.0000449678.86377.f1
Abstracts of the 7th World Congress on Pediatric Critical Care
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1Emergency Medicine, Alder Hey Children's Hospital, Liverpool, United Kingdom 2Paediatric Intensive Care, Royal Manchester Children's Hospital, Manchester, United Kingdom

Background and aims: Approximately 100 children/ year are referred to NWTS with prolonged seizure requiring intubation and ventilation.

Previous NWTS audits have shown an increase in children being extubated at their district general hospital (DGH) following an outreach educational program and regional guideline development.

We aimed to audit these guidelines to demonstrate sustainability and safety.

Aims: To: determine which patients get transferred to PICU; understand current local management including emergency medication; establish if shift towards local extubation is sustained; identify areas of improvement.

Methods: Audit period: 1 January 2013-31 October 2013. If admitted to PICU, discharge summaries/ computer logs were reviewed. Results: compared with previous audit data. Patient consent not required.

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Results:

Effect of Outreach Education and Development of Guidelines for Extubation

Treatment Choices

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Thirty one of 75 intubated patients (41%) were extubated locally within 6 hours.

Adverse events: -2 incidents: DGH requesting flumazenil; anaesthetic team pressures in managing child locally -two deaths: one child not waking after sedation stopped-deviation of guidelines.

Conclusions: Development of guidelines safely increased local extubation of patients intubated for prolonged seizures, provided the guidelines are adhered to. Local staffing levels of the anaesthetic team need to be discussed to provide best possible care, especially as large proportion are extubated in <6hrs. Reinforcement of treatment algorithms to be further addressed -particularly benzodiazepine overuse.

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies