Frequency of Desaturation and Association With Hemodynamic Adverse Events During Tracheal Intubations in PICUs

被引：51

作者：

Li, Simon ^{[1
]}

Hsieh, Ting-Chang ^{[2
]}

Rehder, Kyle J. ^{[3
]}

Nett, Sholeen ^{[4
]}

Kamat, Pradip ^{[5
]}

Napolitano, Natalie ^{[6
]}

Turner, David A. ^{[3
]}

Adu-Darko, Michelle ^{[7
]}

Jarvis, J. Dean ^{[4
]}

Krawiec, Conrad ^{[8
]}

Derbyshire, Ashley T. ^{[8
]}

Meyer, Keith ^{[9
]}

Giuliano, John S., Jr. ^{[10
]}

Tala, Joana ^{[10
]}

Tarquinio, Keiko ^{[5
]}

Ruppe, Michael D. ^{[11
]}

Sanders, Ronald C., Jr. ^{[12
]}

Pinto, Matthew ^{[1
]}

Howell, Joy D. ^{[13
]}

Parker, Margaret M. ^{[14
]}

Nuthall, Gabrielle ^{[15
]}

Shepherd, Michael ^{[16
]}

Emeriaud, Guillaume ^{[17
]}

Nagai, Yuki ^{[18
]}

Saito, Osamu ^{[18
]}

Lee, Jan Hau ^{[19
]}

Simon, Dennis W. ^{[20
]}

Orioles, Alberto ^{[21
]}

Walson, Karen ^{[22
]}

Vanderford, Paula ^{[23
]}

Shenoi, Asha ^{[24
]}

Lee, Anthony ^{[25
]}

Bird, Geoffrey L. ^{[26
]}

Miksa, Michael ^{[27
,28
]}

Graciano, Ana Lia ^{[29
]}

Bain, Jesse ^{[30
]}

Skippen, Peter W. ^{[31
]}

Polikoff, Lee A. ^{[32
]}

Nadkarni, Vinay ^{[33
]}

Nishisaki, Akira ^{[33
]}

机构：

[1] Maria Fareri Childrens Hosp, New York Med Coll, Dept Pediat, Div Crit Care Med, Valhalla, NY USA

[2] Childrens Hosp Philadelphia, Ctr Simulat Adv Educ & Innovat, Philadelphia, PA 19104 USA

[3] Duke Childrens Hosp, Div Pediat Crit Care, Dept Pediat, Durham, NC USA

[4] Childrens Hosp Dartmouth, Div Pediat Crit Care, Dept Pediat, Dartmouth Hitchcock Med Ctr, Lebanon, NH USA

[5] Emory Univ, Sch Med, Dept Pediat, Childrens Hosp Atlanta, Atlanta, GA USA

[6] Childrens Hosp Philadelphia, Dept Resp Care, Philadelphia, PA 19104 USA

[7] Univ Virginia, Childrens Hosp, Dept Pediat, Div Pediat Crit Care, Charlottesville, VA USA

[8] Penn State Hershey Childrens Hosp, Dept Pediat & Publ Hlth Sci, Div Pediat Crit Care Med, Hershey, PA USA

[9] Nicklaus Childrens Hosp, Miami Childrens Hlth Syst, Div Pediat Crit Care Med, Miami, FL USA

[10] Yale Univ, Sch Med, Dept Pediat, Div Crit Care Med, New Haven, CT 06510 USA

[11] Univ Louisville, Sch Med, Dept Pediat, Div Crit Care Med,Norton Childrens Hosp, Louisville, KY 40292 USA

[12] Univ Arkansas, Coll Med, Pediat Crit Care Sect, Dept Pediat, Little Rock, AR USA

[13] Weill Cornell Med Coll, Dept Pediat, New York, NY USA

[14] Stony Brook Childrens Hosp, Dept Pediat, Stony Brook, NY USA

[15] Starship Childrens Hosp, Dept Paediat, Pediat Intens Care Unit, Auckland, New Zealand

[16] Starship Childrens Hosp, Dept Paediat Emergency, Auckland, New Zealand

[17] Univ Montreal, CHU St Justine, Dept Pediat, Montreal, PQ, Canada

[18] Tokyo Metropolitan Childrens Med Ctr, Dept Pediat Emergency & Crit Care Med, Tokyo, Japan

[19] KK Womens & Childrens Hosp, Childrens Intens Care, Singapore, Singapore

[20] Univ Pittsburgh, Sch Med, Dept Crit Care Med, Safar Ctr Resuscitat Res, Pittsburgh, PA USA

[21] Gillette Childrens Hosp, Dept Pediat, Pediat Intens Care, St Paul, MN USA

[22] Emory Univ, Sch Med, Dept Pediat, Childrens Healthcare Atlanta Scottish Rite, Atlanta, GA USA

[23] Oregon Hlth & Sci Univ, Dept Pediat, Div Pediat Crit Care Med, Doernbecher Childrens Hosp, 3181 Sw Sam Jackson Pk Rd, Portland, OR 97201 USA

[24] Univ Kentucky, Sch Med, Dept Pediat, Kentucky Childrens Hosp,Div Pediat Crit Care, Lexington, KY USA

[25] Natl Childrens Hosp, Dept Pediat, Div Crit Care, Columbus, OH USA

[26] Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care Med, Div Cardiac Crit Care Med, Philadelphia, PA USA

[27] Childrens Hosp Montefiore, Dept Pediat Crit Care, Bronx, NY USA

[28] Albert Einstein Coll Med, Bronx, NY USA

[29] Univ Maryland, Sch Med, Dept Pediat, Baltimore, MD 21201 USA

[30] VCU, Childrens Hosp Richmond, Dept Pediat, Div Crit Care Med, Richmond, VA USA

[31] British Columbia Childrens Hosp, Dept Pediat, Intens Care Unit, Vancouver, BC, Canada

[32] Brown Univ, Dept Pediat, Warren Alpert Sch Med, Div Pediat Crit Care Med, Providence, RI 02912 USA

[33] Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care Med, Philadelphia, PA 19104 USA

来源：

PEDIATRIC CRITICAL CARE MEDICINE | 2018年 / 19卷 / 01期

基金：

美国医疗保健研究与质量局;

关键词：

desaturation; intensive care unit; oxygen; pediatric; tracheal intubation; EMERGENCY AIRWAY REGISTRY; NASAL CANNULA OXYGEN; DIRECT LARYNGOSCOPY; VIDEO-LARYNGOSCOPY; ENDOTRACHEAL INTUBATION; CARDIOPULMONARY-RESUSCITATION; OROTRACHEAL INTUBATION; APNEIC OXYGENATION; CHILDREN; VIDEOLARYNGOSCOPY;

D O I：

10.1097/PCC.0000000000001384

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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.

引用

页码：E41 / E50

页数：10

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