Eleanor A Gradidge1, Adnan Bakar2, David Tellez1, Michael Ruppe3, Sarah Tallent4, Geoffrey Bird5, Natasha Lavin6, Anthony Lee7, Michelle Adu-Darko8, Jesse Bain9, Katherine Biagas10, Aline Branca1, Ryan K Breuer11, Calvin Brown12, G Kris Bysani13, Ira M Cheifitz14, Guillaume Emeriaud15, Sandeep Gangadharan16, John S Giuliano17, Joy D Howell18, Conrad Krawiec19, Jan Hau Lee20, Simon Li21, Keith Meyer22, Michael Miksa23, Natalie Napolitano7, Sholeen Nett24, Gabrielle Nuthall25, Alberto Orioles26, Erin B Owen3, Margaret M Parker27, Simon Parsons28, Lee A Polikoff29, Kyle Rehder4, Osamu Saito30, Ronald C Sanders31, Asha N Shenoi32, Dennis W Simon33, Peter W Skippen34, Keiko Tarquinio35, Anne Thompson33, Iris Toedt-Pingel36, Paula Vanderford37, Karen Walson38, Vinay Nadkarni39, Akira Nishisaki39. 1. Division of Pediatric Critical Care, Phoenix Children's Hospital, Phoenix, AZ. 2. Divisions of Pediatric Intensive Care and Cardiology, Cohen Children's Medical Center, Northwell Health System, Hofstra School of Medicine, New Hyde Park, NY. 3. Division of Critical Care Medicine, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, KY. 4. Division of Pediatric Critical Care Medicine, Duke University Hospital, Durham, NC. 5. Division of Cardiac Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 6. Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, PA. 7. Division of Pediatric Critical Care, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH. 8. Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia Children's Hospital, Charlottesville, VA. 9. Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA. 10. Division of Pediatric Critical Care Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY. 11. Division of Critical Care, UBMD Pediatrics, Women and Children's Hospital of Buffalo, University at Buffalo, Buffalo, NY. 12. Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA. 13. Pediatric Acute Care Associates of North Texas PLLC, Medical City Children's Hospital, Dallas, TX. 14. Division of Critical Care, Department of Pediatrics, Duke University Hospital, Durham, NC. 15. Department of Pediatrics, CHU Sainte Justine, Université de Montréal, Montreal, QC, Canada. 16. Department of Pediatric Cardiology, Cohen Children's Medical Center, Northwell Health System, Hofstra School of Medicine, New Hyde Park, NY. 17. Division of Critical Care Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT. 18. Department of Pediatrics, Weill Cornell Medical College, New York, NY. 19. Division of Pediatric Critical Care Medicine, Department of Pediatrics and Public Health Science, Penn State Hershey Children's Hospital, Hershey, PA. 20. Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore. 21. Division of Critical Care Medicine, Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY. 22. Division of Pediatric Critical Care Medicine, Nicklaus Children's Hospital, Miami Children's Health System, Miami, FL. 23. Department of Pediatric Critical Care, Children's Hospital at Montefiore & Albert Einstein College of Medicine, Bronx, NY. 24. Department of Pediatrics, Section of Pediatric Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 25. Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand. 26. Division of Pediatric Critical Care Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN. 27. Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY. 28. Department of Pediatrics, Alberta Children's Hospital, Calgary, AB, Canada. 29. Division of Pediatric Critical Care Medicine, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island. 30. Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. 31. Section of Pediatric Critical Care, Department of Pediatrics, University of Arkansas College of Medicine, Little Rock, AR. 32. Department of Pediatrics, Division of Pediatric Critical Care, Kentucky Children's Hospital, University of Kentucky School of Medicine, Lexington, KY. 33. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 34. Pediatric Intensive Care Unit, BC Children's Hospital, Vancouver, BC, Canada. 35. Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 36. Department of Pediatric Critical Care, University of Vermont College of Medicine, Burlington, VT. 37. Division of Critical Care, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR. 38. Department of Critical Care, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA. 39. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA.
Abstract
OBJECTIVES: Evaluate differences in tracheal intubation-associated events and process variances (i.e., multiple intubation attempts and oxygen desaturation) between pediatric cardiac ICUs and noncardiac PICUs in children with underlying cardiac disease. DESIGN: Retrospective cohort study using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children). SETTING: Thirty-six PICUs (five cardiac ICUs, 31 noncardiac ICUs) from July 2012 to March 2016. PATIENTS: Children with medical or surgical cardiac disease who underwent intubation in an ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our primary outcome was the rate of any adverse tracheal intubation-associated event. Secondary outcomes were severe tracheal intubation-associated events, multiple tracheal intubation attempt rates, and oxygen desaturation. There were 1,502 tracheal intubations in children with underlying cardiac disease (751 in cardiac ICUs, 751 in noncardiac ICUs) reported. Cardiac ICUs and noncardiac ICUs had similar proportions of patients with surgical cardiac disease. Patients undergoing intubation in cardiac ICUs were younger (median age, 1 mo [interquartile range, 0-6 mo]) compared with noncardiac ICUs (median 3 mo [interquartile range, 1-11 mo]; p < 0.001). Tracheal intubation-associated event rates were not different between cardiac ICUs and noncardiac ICUs (16% vs 19%; adjusted odds ratio, 0.74; 95% CI, 0.54-1.02; p = 0.069). However, in a sensitivity analysis comparing cardiac ICUs with mixed ICUs (i.e., ICUs caring for children with either general pediatric or cardiac diseases), cardiac ICUs had decreased odds of adverse events (adjusted odds ratio, 0.71; 95% CI, 0.52-0.97; p = 0.033). Rates of severe tracheal intubation-associated events and multiple attempts were similar. Desaturations occurred more often during intubation in cardiac ICUs (adjusted odds ratio, 1.61; 95% CI, 1.04-1.15; p = 0.002). CONCLUSIONS: In children with underlying cardiac disease, rates of adverse tracheal intubation-associated events were not lower in cardiac ICUs as compared to noncardiac ICUs, even after adjusting for differences in patient characteristics and care models.
OBJECTIVES: Evaluate differences in tracheal intubation-associated events and process variances (i.e., multiple intubation attempts and oxygen desaturation) between pediatric cardiac ICUs and noncardiac PICUs in children with underlying cardiac disease. DESIGN: Retrospective cohort study using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children). SETTING: Thirty-six PICUs (five cardiac ICUs, 31 noncardiac ICUs) from July 2012 to March 2016. PATIENTS: Children with medical or surgical cardiac disease who underwent intubation in an ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our primary outcome was the rate of any adverse tracheal intubation-associated event. Secondary outcomes were severe tracheal intubation-associated events, multiple tracheal intubation attempt rates, and oxygen desaturation. There were 1,502 tracheal intubations in children with underlying cardiac disease (751 in cardiac ICUs, 751 in noncardiac ICUs) reported. Cardiac ICUs and noncardiac ICUs had similar proportions of patients with surgical cardiac disease. Patients undergoing intubation in cardiac ICUs were younger (median age, 1 mo [interquartile range, 0-6 mo]) compared with noncardiac ICUs (median 3 mo [interquartile range, 1-11 mo]; p < 0.001). Tracheal intubation-associated event rates were not different between cardiac ICUs and noncardiac ICUs (16% vs 19%; adjusted odds ratio, 0.74; 95% CI, 0.54-1.02; p = 0.069). However, in a sensitivity analysis comparing cardiac ICUs with mixed ICUs (i.e., ICUs caring for children with either general pediatric or cardiac diseases), cardiac ICUs had decreased odds of adverse events (adjusted odds ratio, 0.71; 95% CI, 0.52-0.97; p = 0.033). Rates of severe tracheal intubation-associated events and multiple attempts were similar. Desaturations occurred more often during intubation in cardiac ICUs (adjusted odds ratio, 1.61; 95% CI, 1.04-1.15; p = 0.002). CONCLUSIONS: In children with underlying cardiac disease, rates of adverse tracheal intubation-associated events were not lower in cardiac ICUs as compared to noncardiac ICUs, even after adjusting for differences in patient characteristics and care models.
Authors: Heidi Meredith Herrick; Kristen M Glass; Lindsay C Johnston; Neetu Singh; Justine Shults; Anne Ades; Vinay Nadkarni; Akira Nishisaki; Elizabeth E Foglia Journal: Neonatology Date: 2019-09-27 Impact factor: 4.035