An International Delphi Survey on the use of Atropine for Critical Care Intubation
Bibliographic record
Abstract
Atropine has almost disappeared from routine anaesthetic practice, but is increasingly recommended and used for intubation of critically ill children. We sought to determine the influences on atropine use during critical care intubation by a group of 61 paediatric intensivists from eight countries in Europe and North and South America, using a Delphi approach. In addition, we wished to establish whether it was possible to give recommendations for atropine use. An expert panel examined clinical indicators or outcomes and atropine-prescribing practices, which potentially could influence atropine prescription. The indicators were formatted into Likert-type questionnaires before being answered by the intensivists in two rounds of structured questioning, with qualitative and quantitative feedback. A stratification into frequent, intermediate and infrequent users, was constructed, according to the frequency of atropine use. Consensus was considered to have been achieved for a median score of ≥7 with ≥75% agreement. We found three areas of consensus: personal practice determines atropine use; there is a risk of death during critical care intubation; and the presence of fever should not influence atropine use. A near-consensus was reached that children are at risk of haemodynamic disturbance. Importantly, there was no consensus that the use of atropine prevents either bradycardia or reduces the risk of hypotension or death during intubation. The use of atropine to prevent haemodynamic instability during intubation remains controversial and consensus was not forthcoming, despite agreement on several risk factors. In particular, the usefulness of atropine to prevent bradycardia, hypotension or death during critical care intubation remains uncertain.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.038 | 0.044 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".