A National Emergency Airway Registry for Children: Landscape of Tracheal Intubation in 15 PICUs

被引:172
作者
Nishisaki, Akira [1 ,2 ]
Turner, David A. [3 ]
Brown, Calvin A., III [4 ]
Walls, Ron M. [4 ]
Nadkarni, Vinay M. [1 ,2 ]
机构
[1] Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care Med, Philadelphia, PA 19104 USA
[2] Childrens Hosp Philadelphia, Ctr Simulat Adv Educ & Innovat, Philadelphia, PA USA
[3] Duke Univ, Med Ctr, Dept Pediat, Div Pediat Crit Care Med,Duke Childrens Hosp, Durham, NC 27710 USA
[4] Harvard Univ, Brigham & Womens Hosp, Dept Emergency Med, Sch Med, Boston, MA 02115 USA
关键词
airway management; child; endotracheal intubation; PICU; tracheal intubation; training; INTENSIVE-CARE-UNIT; RAPID-SEQUENCE INTUBATION; ENDOTRACHEAL INTUBATION; CRITICALLY-ILL; COMPLICATIONS; MANAGEMENT; PREVALENCE; SAFETY; TRIAL;
D O I
10.1097/CCM.0b013e3182746736
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: To characterize the landscape of process of care and safety outcomes for tracheal intubation across pediatric intensive care units Background: Procedural process of care and safety outcomes of tracheal intubation across pediatric intensive care units has not been described. We hypothesize that the novel National Emergency Airway Registry for Children registry is a feasible tool to capture tracheal intubation process of care and outcomes. Design: Prospective, descriptive. Setting: Fifteen academic PICUs in North America. Patients: Critically ill children requiring tracheal intubation in PICUs. Interventions: Tracheal intubation quality improvement data wee prospectively collected for all initial tracheal intubation in 15 PICUs from July 2010 to December 2011 using the National Emergency Airway Registry for Children tool with explicit site-specific compliance plans and operational definitions including adverse tracheal intubation associated events. Measurement and Main Results: One thousand seven hundred fifteen tracheal intubation encounters were reported (averaging 1/3.4 days, or 1/86 bed days). Ninety-eight percent of primary tracheal intubation were successful; 86% were successful with less than or equal to two attempts. First attempt was by pediatric residents in 23%, pediatric critical care fellows in 41%, and critical care attending physicians in 13%: first attempt success rate was 62%, first provider success rate was 79%. The first method was oral intubation in 1,659 (98%) and nasal in 55 (2%). Direct laryngpscopy was used in 96%. Ninety percent of tracheal intubation were with cuffed tracheal tubes. Adverse tracheal intubation associated events were reported in 20% of intubations (n = 372), with severe tracheal intubation associated events in 6% (n = 115). Esophageal intubation with immediate recognition was the most common tracheal intubation associated events (n = 167, 9%). History of difficult airway, diagnostic category, unstable hemodynamics, and resident provider as first airway provider were associated with occurrence of tracheal intubation associated events. Severe tracheal intubation associated events were associated with diagnostic category and pre-existing unstable hemodynamics. Elective tracheal intubation status was associated with fewer severe tracheal intubation associated events. Conclusions: National Emergency Airway Registry for Children was feasible to characterize PICU tracheal intubation procedural process of care and safety outcomes. Self-reported adverse tracheal intubation associated events occurred frequently and were associated with patient, provider, and practice characteristics. (Crit Care Med 2013; 41:874-885)
引用
收藏
页码:874 / 885
页数:12
相关论文
共 28 条
[21]   Rapid sequence intubation for pediatric emergency airway management [J].
Sagarin, MJ ;
Chiang, V ;
Sakles, JC ;
Barton, ED ;
Wolfe, RE ;
Vissers, RJ ;
Walls, RM .
PEDIATRIC EMERGENCY CARE, 2002, 18 (06) :417-423
[22]   Airway management by US and Canadian emergency medicine residents: A multicenter analysis of more than 6,000 endotracheal intubation attempts [J].
Sagarin, MJ ;
Barton, ED ;
Chng, YM ;
Walls, RM .
ANNALS OF EMERGENCY MEDICINE, 2005, 46 (04) :328-336
[23]   MULTIPLE COMPARISONS AND RELATED ISSUES IN THE INTERPRETATION OF EPIDEMIOLOGIC DATA [J].
SAVITZ, DA ;
OLSHAN, AF .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1995, 142 (09) :904-908
[24]   Does the sedative agent facilitate emergency rapid sequence intubation? [J].
Sivilotti, MLA ;
Filbin, MR ;
Murray, HE ;
Slasor, P ;
Walls, RM .
ACADEMIC EMERGENCY MEDICINE, 2003, 10 (06) :612-620
[25]  
Skapik Julia Lynn, 2009, J Patient Saf, V5, P95, DOI 10.1097/PTS.0b013e3181a70c68
[26]   Postoperative Mortality in Children After 101,885 Anesthetics at a Tertiary Pediatric Hospital [J].
van der Griend, Benjamin F. ;
Lister, Nichole A. ;
McKenzie, Ian M. ;
Martin, Nick ;
Ragg, Philip G. ;
Sheppard, Suzette J. ;
Davidson, Andrew J. .
ANESTHESIA AND ANALGESIA, 2011, 112 (06) :1440-1447
[27]   EMERGENCY AIRWAY MANAGEMENT: A MULTI-CENTER REPORT OF 8937 EMERGENCY DEPARTMENT INTUBATIONS [J].
Walls, Ron M. ;
Brown, Calvin A., III ;
Bair, Aaron E. ;
Pallin, Daniel J. .
JOURNAL OF EMERGENCY MEDICINE, 2011, 41 (04) :347-354
[28]   Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications [J].
Wilcox, Susan R. ;
Bittner, Edward A. ;
Elmer, Jonathan ;
Seigel, Todd A. ;
Nguyen, Nicole Thuy P. ;
Dhillon, Anahat ;
Eikermann, Matthias ;
Schmidt, Ulrich .
CRITICAL CARE MEDICINE, 2012, 40 (06) :1808-1813