Simon Li1, Ting-Chang Hsieh2, Kyle J Rehder3, Sholeen Nett4, Pradip Kamat5, Natalie Napolitano6, David A Turner3, Michelle Adu-Darko7, J Dean Jarvis4, Conrad Krawiec8, Ashley T Derbyshire8, Keith Meyer9, John S Giuliano10, Joana Tala10, Keiko Tarquinio5, Michael D Ruppe11, Ronald C Sanders12, Matthew Pinto1, Joy D Howell13, Margaret M Parker14, Gabrielle Nuthall15, Michael Shepherd16, Guillaume Emeriaud17, Yuki Nagai18, Osamu Saito18, Jan Hau Lee19, Dennis W Simon20, Alberto Orioles21, Karen Walson22, Paula Vanderford23, Asha Shenoi24, Anthony Lee25, Geoffrey L Bird26, Michael Miksa27, Ana Lia Graciano28, Jesse Bain29, Peter W Skippen30, Lee A Polikoff31, Vinay Nadkarni32, Akira Nishisaki32. 1. Division of Critical Care Medicine, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY. 2. Center for Simulation, Advanced Education and Innovation, Children's Hospital of Philadelphia, Philadelphia, PA. 3. Division of Pediatric Critical Care, Department of Pediatrics, Duke Children's Hospital, Durham, NC. 4. Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 5. Department of Pediatrics, Emory University School of Medicine, Children's Hospital of Atlanta, Atlanta, GA. 6. Department of Respiratory Care, Children's Hospital of Philadelphia, Philadelphia, PA. 7. Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, VA. 8. Division of Pediatric Critical Care Medicine, Department of Pediatrics and Public Health Science, Penn State Hershey Children's Hospital, Hershey, PA. 9. Division of Pediatric Critical Care Medicine, Nicklaus Children's Hospital, Miami Children's Health System, Miami, FL. 10. Division of Critical Care Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. 11. Division of Critical Care Medicine, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY. 12. Section of Pediatric Critical Care, Department of Pediatrics, University of Arkansas College of Medicine, Little Rock, AR. 13. Department of Pediatrics, Weill Cornell Medical College, New York, NY. 14. Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY. 15. Department of Paediatrics, Pediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand. 16. Department of Paediatric Emergency, Starship Children's Hospital, Auckland, New Zealand. 17. Department of Pediatrics, CHU Sainte Justine, Université de Montréal, Montreal, QC, Canada. 18. Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. 19. Children's Intensive Care, KK Women's and Children's Hospital, Singapore. 20. Safar Center for Resuscitation Research, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 21. Pediatric Intensive Care, Department of Pediatrics, Gillette Children's Hospital, St Paul, MN. 22. Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA. 23. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR. 24. Division of Pediatric Critical Care, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky School of Medicine, Lexington, KY. 25. Division of Critical Care, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH. 26. Division of Cardiac Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 27. Department of Pediatric Critical Care, Children's Hospital at Montefiore & Albert Einstein College of Medicine, Bronx, NY. 28. Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MA. 29. Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA. 30. Intensive Care Unit, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada. 31. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Warren Alpert School of Medicine at Brown University, Providence, RI. 32. Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
Abstract
OBJECTIVES: Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association with adverse hemodynamic tracheal intubation-associated events. DESIGN: Retrospective cohort study as a part of the National Emergency Airway Registry for Children Network's quality improvement project from January 2012 to December 2014. SETTING: International PICUs. PATIENTS: Critically ill children younger than 18 years undergoing primary tracheal intubations in the ICUs. INTERVENTIONS: tracheal intubation processes of care and outcomes were prospectively collected using standardized operational definitions. We defined moderate desaturation as oxygen saturation less than 80% and severe desaturation as oxygen saturation less than 70% during tracheal intubation procedures in children with initial oxygen saturation greater than 90% after preoxygenation. Adverse hemodynamic tracheal intubation-associated event was defined as cardiac arrests, hypo or hypertension requiring intervention, and dysrhythmia. MEASUREMENTS AND MAIN RESULTS: A total of 5,498 primary tracheal intubations from 31 ICUs were reported. Moderate desaturation was observed in 19.3% associated with adverse hemodynamic tracheal intubation-associated events (9.8% among children with moderate desaturation vs 4.4% without desaturation; p < 0.001). Severe desaturation was observed in 12.9% of tracheal intubations, also significantly associated with hemodynamic tracheal intubation-associated events. After adjusting for patient, provider, and practice factors, the occurrence of moderate desaturation was independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 1.83 (95% CI, 1.34-2.51; p < 0.001). The occurrence of severe desaturation was also independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 2.16 (95% CI, 1.54-3.04; p < 0.001). Number of tracheal intubation attempts was also significantly associated with the frequency of moderate and severe desaturations (p < 0.001). CONCLUSIONS: In this large tracheal intubation quality improvement database, we found moderate and severe desaturation are reported among 19% and 13% of all tracheal intubation encounters. Moderate and severe desaturations were independently associated with the occurrence of adverse hemodynamic events. Future quality improvement interventions may focus to reduce desaturation events.
OBJECTIVES:Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association with adverse hemodynamic tracheal intubation-associated events. DESIGN: Retrospective cohort study as a part of the National Emergency Airway Registry for Children Network's quality improvement project from January 2012 to December 2014. SETTING: International PICUs. PATIENTS: Critically ill children younger than 18 years undergoing primary tracheal intubations in the ICUs. INTERVENTIONS: tracheal intubation processes of care and outcomes were prospectively collected using standardized operational definitions. We defined moderate desaturation as oxygen saturation less than 80% and severe desaturation as oxygen saturation less than 70% during tracheal intubation procedures in children with initial oxygen saturation greater than 90% after preoxygenation. Adverse hemodynamic tracheal intubation-associated event was defined as cardiac arrests, hypo or hypertension requiring intervention, and dysrhythmia. MEASUREMENTS AND MAIN RESULTS: A total of 5,498 primary tracheal intubations from 31 ICUs were reported. Moderate desaturation was observed in 19.3% associated with adverse hemodynamic tracheal intubation-associated events (9.8% among children with moderate desaturation vs 4.4% without desaturation; p < 0.001). Severe desaturation was observed in 12.9% of tracheal intubations, also significantly associated with hemodynamic tracheal intubation-associated events. After adjusting for patient, provider, and practice factors, the occurrence of moderate desaturation was independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 1.83 (95% CI, 1.34-2.51; p < 0.001). The occurrence of severe desaturation was also independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 2.16 (95% CI, 1.54-3.04; p < 0.001). Number of tracheal intubation attempts was also significantly associated with the frequency of moderate and severe desaturations (p < 0.001). CONCLUSIONS: In this large tracheal intubation quality improvement database, we found moderate and severe desaturation are reported among 19% and 13% of all tracheal intubation encounters. Moderate and severe desaturations were independently associated with the occurrence of adverse hemodynamic events. Future quality improvement interventions may focus to reduce desaturation events.
Authors: Elizabeth K Laverriere; John E Fiadjoe; Nancy McGowan; Benjamin B Bruins; Natalie Napolitano; Ichiro Watanabe; Nicole K Yamada; Catharine M Walsh; Robert A Berg; Vinay M Nadkarni; Akira Nishisaki Journal: Paediatr Anaesth Date: 2022-06-24 Impact factor: 2.129
Authors: Erin F Hoehn; Preston Dean; Andrew J Lautz; Mary Frey; Mary K Cabrera-Thurman; Gary L Geis; Erika Stalets; Matthew Zackoff; Tena Pham; Andrea Maxwell; Adam Vukovic; Benjamin T Kerrey Journal: Pediatr Qual Saf Date: 2020-10-26
Authors: Berkeley L Bennett; Daniel Scherzer; Delia Gold; Don Buckingham; Andrew McClain; Elaise Hill; Adjoa Andoh; Joseph Christman; Andrew Shonk; Sandra P Spencer Journal: Pediatr Qual Saf Date: 2020-09-25
Authors: Benjamin T Kerrey; Matthew R Mittiga; Stephanie Boyd; Mary Frey; Gary L Geis; Andrea S Rinderknecht; Karen Ahaus; Kartik R Varadarajan; Joseph W Luria; Srikant B Iyer Journal: Pediatr Qual Saf Date: 2021-02-19