Question for Peds Burn Unit

Pediatric Critical Care Columnist · May 18, 2007

We have the ETT wired to a tooth. Works very well. The rest of our care is no different but we have to have wire-cutters at the bedside in case of emergency.

jgsatx · May 19, 2007

Interesting! This method must apply to those older children or at least those not toothless. Who does the intubation, EENT or the trauma surgeons? How do you change ETT position to decrease pressure ulcer occurence? What is your estimated rate of accidental extubation. Have your unit tried other methods in the past like good ol' tape method, securement device or nasal intubation?

Pediatric Critical Care Columnist · May 19, 2007

Usually it's anaesthesia who intubates (sometimes EMS will do it in the field before the kid is transported; they use twill tape to secure until they arrive in ER) and plastics that wires. With extensive facial burns, tape just isn't going to work. It won't stick to sloughing, oozing skin, and is too likely to cause infection. With nasal intubation, which is preferred by our docs but not always possible, tube position isn't changed despite the high risk of pressure injury; with oral tubes it isn't really needed because the tube is centrally fixed and the kid's mouth is often open. ETADs aren't used here for whatever reason (probably $$), but they would work for kids with only upper face or neck burns. Twill tape is used as a last resort because when they swell, and boy do they ever, it acts as a facial tourniquet. Not pretty.

jgsatx · May 21, 2007

Thank you for the information. That was really helpful. Do you mind if I can quote the name of your hospital when I present this idea to my team? Thanks once again.

Pediatric Critical Care Columnist · May 26, 2007

No problem. I'll PM you... trying to keep my head down and my butt out of the wringer.