Quality statement 9: Tracheal intubation and mechanical ventilation in meningococcal septicaemia

Quality statement 9: Tracheal intubation and mechanical ventilation in meningococcal septicaemia

Quality statement

Children and young people with meningococcal septicaemia undergoing tracheal intubation and mechanical ventilation have the procedure undertaken by an anaesthetist experienced in paediatric airway management.

Quality measure

Structure: Evidence of local arrangements for children and young people with meningococcal septicaemia undergoing tracheal intubation and mechanical ventilation to have the procedure undertaken by an anaesthetist experienced in paediatric airway management.

Process: Proportion of children and young people with meningococcal septicaemia undergoing tracheal intubation and mechanical ventilation who have the procedure undertaken by an anaesthetist experienced in paediatric airway management.

Numerator – the number of people in the denominator who have the tracheal intubation and mechanical ventilation procedure undertaken by an anaesthetist experienced in paediatric airway management.

Denominator – the number of children and young people with meningococcal septicaemia undergoing tracheal intubation and mechanical ventilation.

What the quality statement means for different audiences

Service providers ensure systems are in place for children and young people with meningococcal septicaemia undergoing tracheal intubation and mechanical ventilation to have the procedure undertaken by an anaesthetist experienced in paediatric airway management.

Healthcare professionals ensure that children and young people with meningococcal septicaemia undergoing tracheal intubation and mechanical ventilation have the procedure undertaken by an anaesthetist experienced in paediatric airway management.

Commissioners ensure they commission services for children and young people with meningococcal septicaemia undergoing tracheal intubation and mechanical ventilation to have the procedure undertaken by an anaesthetist experienced in paediatric airway management.

Children and young people with meningococcal septicaemia (blood poisoning) receiving help to breathe using a tube inserted into their windpipe (tracheal intubation) through which air is pushed into the lungs via a ventilator machine (ventilation), have the procedure undertaken by an experienced specialist (an anaesthetist experienced in paediatric airway management).

Source guidance

Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management (2010) NICE guideline CG102, recommendations 1.4.30 (key priority for implementation) and 1.4.35

Data source

Structure: Local data collection.

Process: Local data collection. Contained within the baseline assessment for the NICE guideline on meningitis (bacterial) and meningococcal septicaemia in under 16s.

Definitions

Tracheal intubation with mechanical ventilation is required for the following indications.

  • Threatened (for example, loss of gag reflex) or actual loss of airway patency.

  • The need for any form of assisted ventilation, for example bag–mask ventilation.

  • Clinical observation of increasingly laboured breathing.

  • Hypoventilation or apnoea.

  • Features of respiratory failure, including:

    • reduced or fluctuating level of consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 or more)

    • irregular respiration (for example, Cheyne–Stokes breathing)

    • hypoxia (PaO2 less than 13 kPa or 97.5 mmHg) or decreased oxygen saturations in air

    • hypercapnia (PaCO2 greater than 6 kPa or 45 mmHg).

  • Continuing shock following infusion of a total of 40 ml/kg of resuscitation fluid.

  • Signs of raised intracranial pressure.

  • Impaired mental status, including:

    • reduced or fluctuating level of consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 or more)

    • moribund state.

  • Control of intractable seizures.

  • Need for stabilisation and management to allow brain imaging or transfer to the paediatric intensive care unit or another hospital.

[NICE's guideline on meningitis (bacterial) and meningococcal septicaemia in under 16s, recommendation 1.4.37]

An anaesthetist experienced in paediatric airway management is an anaesthetist who has maintained their skills in paediatric resuscitation to the level of advanced paediatric life support or equivalent (for example by undertaking regular supernumerary attachments to paediatric lists or secondments to specialist centres/paediatric simulator work).

In the absence of an anaesthetist, another clinician experienced in paediatric airway management may undertake tracheal intubation and mechanical ventilation for children and young people with meningococcal septicaemia.

A paediatric intensivist should be consulted by the clinician undertaking tracheal intubation and mechanical ventilation.