Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes

Margaret M. Parker, Gabrielle Nuthall, Calvin Brown, Katherine Biagas, Natalie Napolitano, Lee A. Polikoff, Dennis Simon, Michael Miksa, Eleanor Gradidge, Jan Hau Lee, Ashwin S. Krishna, David Tellez, Geoffrey L. Bird, Kyle J. Rehder, David A. Turner, Michelle Adu-Darko, Sholeen T. Nett, Ashley T. Derbyshire, Keith Meyer, John GiulianoErin B. Owen, Janice E. Sullivan, Keiko Tarquinio, Pradip Kamat, Ronald C. Sanders, Matthew Pinto, Kris K. Bysani, Guillaume Emeriaud, Yuki Nagai, Melissa A. McCarthy, Karen H. Walson, Paula Vanderford, Anthony Lee, Jesse Bain, Peter Skippen, Ryan Breuer, Sarah Tallent, Vinay Nadkarni, Akira Nishisaki, for the National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

OBJECTIVE:: Tracheal intubation in PICUs is a common procedure often associated with adverse events. The aim of this study is to evaluate the association between immediate events such as tracheal intubation associated events or desaturation and ICU outcomes: length of stay, duration of mechanical ventilation, and mortality. STUDY DESIGN:: Prospective cohort study with 35 PICUs using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from January 2013 to June 2015. Desaturation defined as Spo2 less than 80%. SETTING:: PICUs participating in NEAR4KIDS. PATIENTS:: All patients less than18 years of age undergoing primary tracheal intubations with ICU outcome data were analyzed. MEASUREMENTS AND MAIN RESULTS:: Five thousand five hundred four tracheal intubation encounters with median 108 (interquartile range, 58–229) tracheal intubations per site. At least one tracheal intubation associated event was reported in 892 (16%), with 364 (6.6%) severe tracheal intubation associated events. Infants had a higher frequency of tracheal intubation associated event or desaturation than older patients (48% infants vs 34% for 1–7 yr and 18% for 8–17 yr). In univariate analysis, the occurrence of tracheal intubation associated event or desaturation was associated with a longer mechanical ventilation (5 vs 3 d; p < 0.001) and longer PICU stay (14 vs 11 d; p < 0.001) but not with PICU mortality. The occurrence of severe tracheal intubation associated events was associated with longer mechanical ventilation (5 vs 4 d; p< 0.003), longer PICU stay (15 vs 12 d; p < 0.035), and PICU mortality (19.9% vs 9.6%; p < 0.0001). In multivariable analyses, the occurrence of tracheal intubation associated event or desaturation was significantly associated with longer mechanical ventilation (+12%; 95% CI, 4–21%; p = 0.004), and severe tracheal intubation associated events were independently associated with increased PICU mortality (OR = 1.80; 95% CI, 1.24–2.60; p = 0.002), after adjusted for patient confounders. CONCLUSIONS:: Adverse tracheal intubation associated events and desaturations are common and associated with longer mechanical ventilation in critically ill children. Severe tracheal intubation associated events are associated with higher ICU mortality. Potential interventions to decrease tracheal intubation associated events and oxygen desaturation, such as tracheal intubation checklist, use of apneic oxygenation, and video laryngoscopy, may need to be considered to improve ICU outcomes.

Original languageEnglish (US)
JournalPediatric Critical Care Medicine
DOIs
StateAccepted/In press - Feb 14 2017

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Intubation
Artificial Respiration
Mortality
Laryngoscopy
Quality Improvement
Checklist
Critical Illness
Registries
Length of Stay

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Parker, M. M., Nuthall, G., Brown, C., Biagas, K., Napolitano, N., Polikoff, L. A., ... for the National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network (Accepted/In press). Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes. Pediatric Critical Care Medicine. https://doi.org/10.1097/PCC.0000000000001074

Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes. / Parker, Margaret M.; Nuthall, Gabrielle; Brown, Calvin; Biagas, Katherine; Napolitano, Natalie; Polikoff, Lee A.; Simon, Dennis; Miksa, Michael; Gradidge, Eleanor; Lee, Jan Hau; Krishna, Ashwin S.; Tellez, David; Bird, Geoffrey L.; Rehder, Kyle J.; Turner, David A.; Adu-Darko, Michelle; Nett, Sholeen T.; Derbyshire, Ashley T.; Meyer, Keith; Giuliano, John; Owen, Erin B.; Sullivan, Janice E.; Tarquinio, Keiko; Kamat, Pradip; Sanders, Ronald C.; Pinto, Matthew; Bysani, Kris K.; Emeriaud, Guillaume; Nagai, Yuki; McCarthy, Melissa A.; Walson, Karen H.; Vanderford, Paula; Lee, Anthony; Bain, Jesse; Skippen, Peter; Breuer, Ryan; Tallent, Sarah; Nadkarni, Vinay; Nishisaki, Akira; for the National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.

In: Pediatric Critical Care Medicine, 14.02.2017.

Research output: Contribution to journalArticle

Parker, MM, Nuthall, G, Brown, C, Biagas, K, Napolitano, N, Polikoff, LA, Simon, D, Miksa, M, Gradidge, E, Lee, JH, Krishna, AS, Tellez, D, Bird, GL, Rehder, KJ, Turner, DA, Adu-Darko, M, Nett, ST, Derbyshire, AT, Meyer, K, Giuliano, J, Owen, EB, Sullivan, JE, Tarquinio, K, Kamat, P, Sanders, RC, Pinto, M, Bysani, KK, Emeriaud, G, Nagai, Y, McCarthy, MA, Walson, KH, Vanderford, P, Lee, A, Bain, J, Skippen, P, Breuer, R, Tallent, S, Nadkarni, V, Nishisaki, A & for the National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network 2017, 'Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes', Pediatric Critical Care Medicine. https://doi.org/10.1097/PCC.0000000000001074
Parker, Margaret M. ; Nuthall, Gabrielle ; Brown, Calvin ; Biagas, Katherine ; Napolitano, Natalie ; Polikoff, Lee A. ; Simon, Dennis ; Miksa, Michael ; Gradidge, Eleanor ; Lee, Jan Hau ; Krishna, Ashwin S. ; Tellez, David ; Bird, Geoffrey L. ; Rehder, Kyle J. ; Turner, David A. ; Adu-Darko, Michelle ; Nett, Sholeen T. ; Derbyshire, Ashley T. ; Meyer, Keith ; Giuliano, John ; Owen, Erin B. ; Sullivan, Janice E. ; Tarquinio, Keiko ; Kamat, Pradip ; Sanders, Ronald C. ; Pinto, Matthew ; Bysani, Kris K. ; Emeriaud, Guillaume ; Nagai, Yuki ; McCarthy, Melissa A. ; Walson, Karen H. ; Vanderford, Paula ; Lee, Anthony ; Bain, Jesse ; Skippen, Peter ; Breuer, Ryan ; Tallent, Sarah ; Nadkarni, Vinay ; Nishisaki, Akira ; for the National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. / Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes. In: Pediatric Critical Care Medicine. 2017.
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title = "Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes",
abstract = "OBJECTIVE:: Tracheal intubation in PICUs is a common procedure often associated with adverse events. The aim of this study is to evaluate the association between immediate events such as tracheal intubation associated events or desaturation and ICU outcomes: length of stay, duration of mechanical ventilation, and mortality. STUDY DESIGN:: Prospective cohort study with 35 PICUs using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from January 2013 to June 2015. Desaturation defined as Spo2 less than 80{\%}. SETTING:: PICUs participating in NEAR4KIDS. PATIENTS:: All patients less than18 years of age undergoing primary tracheal intubations with ICU outcome data were analyzed. MEASUREMENTS AND MAIN RESULTS:: Five thousand five hundred four tracheal intubation encounters with median 108 (interquartile range, 58–229) tracheal intubations per site. At least one tracheal intubation associated event was reported in 892 (16{\%}), with 364 (6.6{\%}) severe tracheal intubation associated events. Infants had a higher frequency of tracheal intubation associated event or desaturation than older patients (48{\%} infants vs 34{\%} for 1–7 yr and 18{\%} for 8–17 yr). In univariate analysis, the occurrence of tracheal intubation associated event or desaturation was associated with a longer mechanical ventilation (5 vs 3 d; p < 0.001) and longer PICU stay (14 vs 11 d; p < 0.001) but not with PICU mortality. The occurrence of severe tracheal intubation associated events was associated with longer mechanical ventilation (5 vs 4 d; p< 0.003), longer PICU stay (15 vs 12 d; p < 0.035), and PICU mortality (19.9{\%} vs 9.6{\%}; p < 0.0001). In multivariable analyses, the occurrence of tracheal intubation associated event or desaturation was significantly associated with longer mechanical ventilation (+12{\%}; 95{\%} CI, 4–21{\%}; p = 0.004), and severe tracheal intubation associated events were independently associated with increased PICU mortality (OR = 1.80; 95{\%} CI, 1.24–2.60; p = 0.002), after adjusted for patient confounders. CONCLUSIONS:: Adverse tracheal intubation associated events and desaturations are common and associated with longer mechanical ventilation in critically ill children. Severe tracheal intubation associated events are associated with higher ICU mortality. Potential interventions to decrease tracheal intubation associated events and oxygen desaturation, such as tracheal intubation checklist, use of apneic oxygenation, and video laryngoscopy, may need to be considered to improve ICU outcomes.",
author = "Parker, {Margaret M.} and Gabrielle Nuthall and Calvin Brown and Katherine Biagas and Natalie Napolitano and Polikoff, {Lee A.} and Dennis Simon and Michael Miksa and Eleanor Gradidge and Lee, {Jan Hau} and Krishna, {Ashwin S.} and David Tellez and Bird, {Geoffrey L.} and Rehder, {Kyle J.} and Turner, {David A.} and Michelle Adu-Darko and Nett, {Sholeen T.} and Derbyshire, {Ashley T.} and Keith Meyer and John Giuliano and Owen, {Erin B.} and Sullivan, {Janice E.} and Keiko Tarquinio and Pradip Kamat and Sanders, {Ronald C.} and Matthew Pinto and Bysani, {Kris K.} and Guillaume Emeriaud and Yuki Nagai and McCarthy, {Melissa A.} and Walson, {Karen H.} and Paula Vanderford and Anthony Lee and Jesse Bain and Peter Skippen and Ryan Breuer and Sarah Tallent and Vinay Nadkarni and Akira Nishisaki and {for the National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network}",
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TY - JOUR

T1 - Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes

AU - Parker, Margaret M.

AU - Nuthall, Gabrielle

AU - Brown, Calvin

AU - Biagas, Katherine

AU - Napolitano, Natalie

AU - Polikoff, Lee A.

AU - Simon, Dennis

AU - Miksa, Michael

AU - Gradidge, Eleanor

AU - Lee, Jan Hau

AU - Krishna, Ashwin S.

AU - Tellez, David

AU - Bird, Geoffrey L.

AU - Rehder, Kyle J.

AU - Turner, David A.

AU - Adu-Darko, Michelle

AU - Nett, Sholeen T.

AU - Derbyshire, Ashley T.

AU - Meyer, Keith

AU - Giuliano, John

AU - Owen, Erin B.

AU - Sullivan, Janice E.

AU - Tarquinio, Keiko

AU - Kamat, Pradip

AU - Sanders, Ronald C.

AU - Pinto, Matthew

AU - Bysani, Kris K.

AU - Emeriaud, Guillaume

AU - Nagai, Yuki

AU - McCarthy, Melissa A.

AU - Walson, Karen H.

AU - Vanderford, Paula

AU - Lee, Anthony

AU - Bain, Jesse

AU - Skippen, Peter

AU - Breuer, Ryan

AU - Tallent, Sarah

AU - Nadkarni, Vinay

AU - Nishisaki, Akira

AU - for the National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

PY - 2017/2/14

Y1 - 2017/2/14

N2 - OBJECTIVE:: Tracheal intubation in PICUs is a common procedure often associated with adverse events. The aim of this study is to evaluate the association between immediate events such as tracheal intubation associated events or desaturation and ICU outcomes: length of stay, duration of mechanical ventilation, and mortality. STUDY DESIGN:: Prospective cohort study with 35 PICUs using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from January 2013 to June 2015. Desaturation defined as Spo2 less than 80%. SETTING:: PICUs participating in NEAR4KIDS. PATIENTS:: All patients less than18 years of age undergoing primary tracheal intubations with ICU outcome data were analyzed. MEASUREMENTS AND MAIN RESULTS:: Five thousand five hundred four tracheal intubation encounters with median 108 (interquartile range, 58–229) tracheal intubations per site. At least one tracheal intubation associated event was reported in 892 (16%), with 364 (6.6%) severe tracheal intubation associated events. Infants had a higher frequency of tracheal intubation associated event or desaturation than older patients (48% infants vs 34% for 1–7 yr and 18% for 8–17 yr). In univariate analysis, the occurrence of tracheal intubation associated event or desaturation was associated with a longer mechanical ventilation (5 vs 3 d; p < 0.001) and longer PICU stay (14 vs 11 d; p < 0.001) but not with PICU mortality. The occurrence of severe tracheal intubation associated events was associated with longer mechanical ventilation (5 vs 4 d; p< 0.003), longer PICU stay (15 vs 12 d; p < 0.035), and PICU mortality (19.9% vs 9.6%; p < 0.0001). In multivariable analyses, the occurrence of tracheal intubation associated event or desaturation was significantly associated with longer mechanical ventilation (+12%; 95% CI, 4–21%; p = 0.004), and severe tracheal intubation associated events were independently associated with increased PICU mortality (OR = 1.80; 95% CI, 1.24–2.60; p = 0.002), after adjusted for patient confounders. CONCLUSIONS:: Adverse tracheal intubation associated events and desaturations are common and associated with longer mechanical ventilation in critically ill children. Severe tracheal intubation associated events are associated with higher ICU mortality. Potential interventions to decrease tracheal intubation associated events and oxygen desaturation, such as tracheal intubation checklist, use of apneic oxygenation, and video laryngoscopy, may need to be considered to improve ICU outcomes.

AB - OBJECTIVE:: Tracheal intubation in PICUs is a common procedure often associated with adverse events. The aim of this study is to evaluate the association between immediate events such as tracheal intubation associated events or desaturation and ICU outcomes: length of stay, duration of mechanical ventilation, and mortality. STUDY DESIGN:: Prospective cohort study with 35 PICUs using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from January 2013 to June 2015. Desaturation defined as Spo2 less than 80%. SETTING:: PICUs participating in NEAR4KIDS. PATIENTS:: All patients less than18 years of age undergoing primary tracheal intubations with ICU outcome data were analyzed. MEASUREMENTS AND MAIN RESULTS:: Five thousand five hundred four tracheal intubation encounters with median 108 (interquartile range, 58–229) tracheal intubations per site. At least one tracheal intubation associated event was reported in 892 (16%), with 364 (6.6%) severe tracheal intubation associated events. Infants had a higher frequency of tracheal intubation associated event or desaturation than older patients (48% infants vs 34% for 1–7 yr and 18% for 8–17 yr). In univariate analysis, the occurrence of tracheal intubation associated event or desaturation was associated with a longer mechanical ventilation (5 vs 3 d; p < 0.001) and longer PICU stay (14 vs 11 d; p < 0.001) but not with PICU mortality. The occurrence of severe tracheal intubation associated events was associated with longer mechanical ventilation (5 vs 4 d; p< 0.003), longer PICU stay (15 vs 12 d; p < 0.035), and PICU mortality (19.9% vs 9.6%; p < 0.0001). In multivariable analyses, the occurrence of tracheal intubation associated event or desaturation was significantly associated with longer mechanical ventilation (+12%; 95% CI, 4–21%; p = 0.004), and severe tracheal intubation associated events were independently associated with increased PICU mortality (OR = 1.80; 95% CI, 1.24–2.60; p = 0.002), after adjusted for patient confounders. CONCLUSIONS:: Adverse tracheal intubation associated events and desaturations are common and associated with longer mechanical ventilation in critically ill children. Severe tracheal intubation associated events are associated with higher ICU mortality. Potential interventions to decrease tracheal intubation associated events and oxygen desaturation, such as tracheal intubation checklist, use of apneic oxygenation, and video laryngoscopy, may need to be considered to improve ICU outcomes.

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