Ronald C Sanders1, Sholeen T Nett2, Katherine Finn Davis3, Margaret M Parker4, G Kris Bysani5, Michelle Adu-Darko6, Geoffrey L Bird7, Ira M Cheifetz8, Ashley T Derbyshire9, Guillaume Emeriaud10, John S Giuliano11, Ana Lia Graciano12, Yusuke Hagiwara13, Glenda Hefley1, Takanari Ikeyama13, J Dean Jarvis2, Pradip Kamat14, Ashwin S Krishna15, Anthony Lee16, Jan Hau Lee17, Simon Li18, Keith Meyer19, Vicki L Montgomery20, Yuki Nagai13, Matthew Pinto18, Kyle J Rehder8, Osamu Saito13, Asha N Shenoi15, Hester Christianne Taekema21, Keiko M Tarquinio22, Ann E Thompson23, David A Turner8, Vinay M Nadkarni24, Akira Nishisaki24. 1. Section of Pediatric Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock. 2. Division of Pediatric Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 3. Center for Pediatric Nursing Research and Evidence Based Practice, Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 4. Department of Pediatrics, Pediatric Critical Care Medicine, Stony Brook Children's Hospital, Stony Brook, New York. 5. Pediatric Acute Care Associates of North Texas PLLC, Medical City Children's Hospital, Dallas. 6. University of Virginia Children's Hospital, Charlottesville. 7. Division of Cardiac Critical Care Medicine, Department of Pediatrics and Anesthesia/Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 8. Division of Critical Care, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina. 9. Penn State Hershey Children's Hospital, Hershey, Pennsylvania. 10. Sainte-Justine University Hospital Center, Montreal, Quebec, Canada. 11. Yale University School of Medicine, New Haven, Connecticut. 12. Pediatric Critical Care Medicine, Children's Hospital of Central California, Fresno. 13. Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. 14. Department of Pediatrics, Emory University School of Medicine, Children's Hospital of Atlanta, Atlanta, Georgia. 15. Department of Pediatrics, Division of Pediatric Critical Care, Kentucky Children's Hospital, University of Kentucky School of Medicine, Lexington. 16. Nationwide Children's Hospital, Ohio State University, Columbus. 17. KK Women's and Children's Hospital, Singapore. 18. Pediatric Intensive Care Unit, Maria Fareri Children's Hospital, Westchester, New York. 19. Division of Critical Care Medicine, Miami Children's Hospital, Miami, Florida. 20. Division of Critical Care, Department of Pediatrics, University of Louisville and Kosair Children's Hospital, Louisville, Kentucky. 21. Starship Hospital, Auckland, New Zealand. 22. Critical Care Medicine, Rhode Island/Hasbro Children's Hospital, Providence. 23. Critical Care Medicine and Pediatrics, Pittsburgh Children's Hospital, Pittsburgh, Pennsylvania. 24. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Abstract
IMPORTANCE: Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal intubation (TI) in pediatric intensive care units (PICUs). Family presence during procedures in PICUs has been advocated. OBJECTIVE: To describe the current practice of FP during TI and evaluate the association with procedural and clinician (including physician, respiratory therapist, and nurse practitioner) outcomes across multiple PICUs. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study in which all TIs from July 2010 to March 2014 in the multicenter TI database (National Emergency Airway Registry for Children [NEAR4KIDS]) were analyzed. Family presence was defined as a family member present during TI. This study included all TIs in patients younger than 18 years in 22 international PICUs. EXPOSURES: Family presence and no FP during TI in the PICU. MAIN OUTCOMES AND MEASURES: The percentage of FP during TIs. First attempt success rate, adverse TI-associated events, multiple attempts (≥ 3), oxygen desaturation (oxygen saturation as measured by pulse oximetry <80%), and self-reported team stress level. RESULTS: A total of 4969 TI encounters were reported. Among those, 81% (n = 4030) of TIs had documented FP status (with/without). The median age of participants with FP was 2 years and 1 year for those without FP. The average percentage of TIs with FP was 19% and varied widely across sites (0%-43%; P < .001). Tracheal intubations with FP (vs without FP) were associated with older patients (median, 2 years vs 1 year; P = .04), lower Paediatric Index of Mortality 2 score, and pediatric resident as the first airway clinician (23%, n = 179 vs 18%, n = 584; odds ratio [OR], 1.4; 95% CI, 1.2-1.7). Tracheal intubations with FP and without FP were no different in the first attempt success rate (OR, 1.00; 95% CI, 0.85-1.18), adverse TI-associated events (any events: OR, 1.06; 95% CI, 0.85-1.30 and severe events: OR, 1.04; 95% CI, 0.75-1.43), multiple attempts (≥ 3) (OR, 1.03; 95% CI, 0.82-1.28), oxygen desaturation (oxygen saturation <80%) (OR, 0.97; 95% CI, 0.80-1.18), or self-reported team stress level (OR, 1.09; 95% CI, 0.92-1.31). This result persisted after adjusting for patient and clinician confounders. CONCLUSIONS AND RELEVANCE: Wide variability exists in FP during TIs across PICUs. Family presence was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (<80%), or higher team stress level. Our data suggest that FP during TI can safely be implemented as part of a family-centered care model in the PICU.
IMPORTANCE: Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal intubation (TI) in pediatric intensive care units (PICUs). Family presence during procedures in PICUs has been advocated. OBJECTIVE: To describe the current practice of FP during TI and evaluate the association with procedural and clinician (including physician, respiratory therapist, and nurse practitioner) outcomes across multiple PICUs. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study in which all TIs from July 2010 to March 2014 in the multicenter TI database (National Emergency Airway Registry for Children [NEAR4KIDS]) were analyzed. Family presence was defined as a family member present during TI. This study included all TIs in patients younger than 18 years in 22 international PICUs. EXPOSURES: Family presence and no FP during TI in the PICU. MAIN OUTCOMES AND MEASURES: The percentage of FP during TIs. First attempt success rate, adverse TI-associated events, multiple attempts (≥ 3), oxygen desaturation (oxygen saturation as measured by pulse oximetry <80%), and self-reported team stress level. RESULTS: A total of 4969 TI encounters were reported. Among those, 81% (n = 4030) of TIs had documented FP status (with/without). The median age of participants with FP was 2 years and 1 year for those without FP. The average percentage of TIs with FP was 19% and varied widely across sites (0%-43%; P < .001). Tracheal intubations with FP (vs without FP) were associated with older patients (median, 2 years vs 1 year; P = .04), lower Paediatric Index of Mortality 2 score, and pediatric resident as the first airway clinician (23%, n = 179 vs 18%, n = 584; odds ratio [OR], 1.4; 95% CI, 1.2-1.7). Tracheal intubations with FP and without FP were no different in the first attempt success rate (OR, 1.00; 95% CI, 0.85-1.18), adverse TI-associated events (any events: OR, 1.06; 95% CI, 0.85-1.30 and severe events: OR, 1.04; 95% CI, 0.75-1.43), multiple attempts (≥ 3) (OR, 1.03; 95% CI, 0.82-1.28), oxygen desaturation (oxygen saturation <80%) (OR, 0.97; 95% CI, 0.80-1.18), or self-reported team stress level (OR, 1.09; 95% CI, 0.92-1.31). This result persisted after adjusting for patient and clinician confounders. CONCLUSIONS AND RELEVANCE: Wide variability exists in FP during TIs across PICUs. Family presence was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (<80%), or higher team stress level. Our data suggest that FP during TI can safely be implemented as part of a family-centered care model in the PICU.
Authors: Aayush Gabrani; Taiki Kojima; Ronald C Sanders; Asha Shenoi; Vicki Montgomery; Simon J Parsons; Sandeep Gangadharan; Sholeen Nett; Natalie Napolitano; Keiko Tarquinio; Dennis W Simon; Anthony Lee; Guillaume Emeriaud; Michelle Adu-Darko; John S Giuliano; Keith Meyer; Ana Lia Graciano; David A Turner; Conrad Krawiec; Adnan M Bakar; Lee A Polikoff; Margaret Parker; Ilana Harwayne-Gidansky; Benjamin Crulli; Paula Vanderford; Ryan K Breuer; Eleanor Gradidge; Aline Branca; Lily B Glater-Welt; David Tellez; Lisa V Wright; Matthew Pinto; Vinay Nadkarni; Akira Nishisaki Journal: Pediatr Crit Care Med Date: 2018-05 Impact factor: 3.624
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