Eleanor A Gradidge1, Adnan Bakar2, David Tellez1, Michael Ruppe3, Sarah Tallent4, Geoffrey Bird5, Natasha Lavin6, Anthony Lee7, Vinay Nadkarni8, Michelle Adu-Darko9, Jesse Bain10, Katherine Biagas11, Aline Branca1, Ryan K Breuer12, Calvin Brown13, Kris Bysani14, Guillaume Emeriaud15, Sandeep Gangadharan2, John S Giuliano16, Joy D Howell17, Conrad Krawiec18, Jan Hau Lee19, Simon Li20, Keith Meyer21, Michael Miksa22, Natalie Napolitano6, Sholeen Nett23, Gabrielle Nuthall24, Alberto Orioles25, Erin B Owen3, Margaret M Parker26, Simon Parsons27, Lee A Polikoff28, Kyle Rehder4, Osamu Saito29, Ron C Sanders30, Asha Shenoi31, Dennis W Simon32, Peter W Skippen33, Keiko Tarquinio34, Anne Thompson32, Iris Toedt-Pingel35, Karen Walson36, Akira Nishisaki8. 1. 1Division of Pediatric Critical Care,Phoenix Children's Hospital,Phoenix,AZ,USA. 2. 2Pediatric Cardiology,Cohen Children's Medical Center,Northwell Health System,Hofstra School of Medicine,New Hyde Park,NY,USA. 3. 3Department of Pediatrics,Division of Critical Care Medicine,University of Louisville School of Medicine,Norton Children's Hospital,Louisville,KY,USA. 4. 4Division of Pediatric Critical Care Medicine,Duke University Hospital,Durham,NC,USA. 5. 5Division of Cardiac Critical Care Medicine,The Children's Hospital of Philadelphia,Philadelphia,PA,USA. 6. 6Respiratory Care Department,The Children's Hospital of Philadelphia,Philadelphia,PA,USA. 7. 7Department of Pediatrics,Ohio State University College of Medicine,Nationwide Children's Hospital,Columbus,OH,USA. 8. 8Department of Anesthesiology and Critical Care Medicine,The Children's Hospital of Philadelphia,Philadelphia,PA,USA. 9. 9Department of Pediatrics,Division of Pediatric Critical Care,University of Virginia Children's Hospital,Charlottesville,VA,USA. 10. 10Department of Pediatrics,Division of Critical Care Medicine,Children's Hospital of Richmond at VCU,Richmond,VA,USA. 11. 11Division of Pediatric Critical Care Medicine,New York Presbyterian Hospital,Columbia University Medical Center,New York,NY,USA. 12. 12Division of Critical Care,UBMD Pediatrics,Women and Children's Hospital of Buffalo,University at Buffalo,Buffalo,NY,USA. 13. 13Department of Emergency Medicine,Harvard Medical School,Brigham and Women's Hospital,Boston,MA,USA. 14. 14Pediatric Acute Care Associates of North Texas PLLC,Medical City Children's Hospital,Dallas,TX,USA. 15. 15Department of Pediatrics,CHU Sainte Justine,Université de Montréal,Montreal,QC,Canada. 16. 16Department of Pediatrics,Division of Critical Care Medicine,Yale University School of Medicine,New Haven,CT,USA. 17. 17Department of Pediatrics,Weill Cornell Medical College,New York,NY,USA. 18. 18Division of Pediatrics Critical Care Medicine,Department of Pediatrics and Public Health Science,Penn State Hershey Children's Hospital,Hershey,PA,USA. 19. 19KK Women's and Children's Hospital,Singapore,Singapore. 20. 20Department of Pediatrics,Division of Critical Care Medicine,New York Medical College,Maria Fareri Children's Hospital,Valhalla,NY,USA. 21. 21Nicklaus Children's Hospital,Miami Children's Health System,Miami,FL,USA. 22. 22Department of Pediatric Critical Care,Children's Hospital at Montefiore,Albert Einstein College of Medicine,Bronx,NY,USA. 23. 23Department of Pediatrics,Section of Pediatric Critical Care Medicine,Dartmouth-Hitchcock Medical Center,Lebanon,NH,USA. 24. 24Paediatric Intensive Care Unit,Starship Children's Hospital,Auckland,New Zealand. 25. 25Children's Respiratory and Critical Care Specialist,Children's Hospitals and Clinics of Minnesota,Minneapolis,MN,USA. 26. 26Department of Pediatrics,Stony Brook Children's Hospital,Stony Brook,NY,USA. 27. 27Department of Critical Care,Alberta Children's Hospital,Calgary,AB,Canada. 28. 28Division of Pediatric Critical Care Medicine,The Warren Alpert School of Medicine at Brown University,Providence,RI,USA. 29. 29Department of Pediatric Emergency and Critical Care Medicine,Tokyo Metropolitan Children's Medical Center,Tokyo,Japan. 30. 30Section of Pediatric Critical Care,Department of Pediatrics,University of Arkansas College of Medicine,Little Rock,AR,USA. 31. 31Department of Pediatrics,Division of Pediatric Critical Care,Kentucky Children's Hospital,University of Kentucky College of Medicine,Lexington,KY,USA. 32. 32University of Pittsburgh School of Medicine,Pittsburgh,PA,USA. 33. 33Pediatric Intensive Care Unit,BC Children's Hospital,Vancouver,BC,Canada. 34. 34Department of Pediatrics,Division of Pediatric Critical Care Medicine,Emory University School of Medicine,Atlanta,GA,USA. 35. 35Pediatric Critical Care,University of Vermont College of Medicine,Burlington,VT,USA. 36. 36Department of Critical Care,Children's Healthcare of Atlanta at Scottish Rite,Atlanta,GA,USA.
Abstract
IntroductionChildren with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.Materials and methodsWe sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation. RESULTS: A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease. CONCLUSIONS: The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
IntroductionChildren with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.Materials and methodsWe sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation. RESULTS: A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease. CONCLUSIONS: The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
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