Family Presence During Pediatric Tracheal Intubations

Abstract

IMPORTANCE Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal intubation (TI) in pediatric intensive care units (PICUs). Family presence during procedures in PICUs has been advocated.OBJECTIVE To describe the current practice of FP during TI and evaluate the association with procedural and clinician (including physician, respiratory therapist, and nurse practitioner) outcomes across multiple PICUs. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study in which all TIs from July 2010 to March 2014 in the multicenter TI database (National Emergency Airway Registry for Children [NEAR4KIDS]) were analyzed. Family presence was defined as a family member present during TI. This study included all TIs in patients younger than 18 years in 22 international PICUs.EXPOSURES Family presence and no FP during TI in the PICU. MAIN OUTCOMES AND MEASURESThe percentage of FP during TIs. First attempt success rate, adverse TI-associated events, multiple attempts (Ն3), oxygen desaturation (oxygen saturation as measured by pulse oximetry <80%), and self-reported team stress level.RESULTS A total of 4969 TI encounters were reported. Among those, 81% (n = 4030) of TIs had documented FP status (with/without). The median age of participants with FP was 2 years and 1 year for those without FP. The average percentage of TIs with FP was 19% and varied widely across sites (0%-43%; P < .001). Tracheal intubations with FP (vs without FP) were associated with older patients (median, 2 years vs 1 year; P = .04), lower Paediatric Index of Mortality 2 score, and pediatric resident as the first airway clinician (23%, n = 179 vs 18%, n = 584; odds ratio [OR], 1.4; 95% CI, 1.2-1.7). Tracheal intubations with FP and without FP were no different in the first attempt success rate (OR, 1.00; 95% CI, 0.85-1.18), adverse TI-associated events (any events: OR, 1.06; 95% CI, 0.85-1.30 and severe events: OR, 1.04; 95% CI, 0.75-1.43), multiple attempts (Ն3) (OR, 1.03; 95% CI, 0.82-1.28), oxygen desaturation (oxygen saturation <80%) (OR, 0.97; 95% CI, 0.80-1.18), or self-reported team stress level (OR, 1.09; 95% CI, 0.92-1.31). This result persisted after adjusting for patient and clinician confounders.CONCLUSIONS AND RELEVANCE Wide variability exists in FP during TIs across PICUs. Family presence was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (<80%), or higher team stress level. Our data suggest that FP during TI can safely be implemented as part of a family-centered care model in the PICU.

Effect of an audience on trainee stress and performance during simulated neonatal intubation: a randomized crossover trial

“…The presence of family members, which is a particular kind of audience, during procedures, has been studied in recent literature. In a retrospective study, the presence of family members did not have an impact on the success of pediatric intubation [ 20 ]. However, junior residents are not in favor of the presence of family because they are worried about being judged by the parents [ 21 , 22 ].…”

Pediatric In-Hospital Acute Respiratory Compromise: A Report From the American Heart Association’s Get With the Guidelines-Resuscitation Registry*

“…(9–16) In the pediatric ICU setting, severe adverse events occurred in approximately 6% of cases and less than 2% of patients progressed to cardiac arrest during the event. (11, 14) Similar, or slightly higher, cardiac arrest event rates have been described in the ED for pediatric(18) and adult(30, 31) patients in relation to emergency intubation.…”

“…Pediatric intubation has been extensively described in the intensive care unit (ICU)(9–16) and emergency department (ED) setting. (17, 18) However, to our knowledge, no large, multi-center study has described the landscape of in-hospital acute respiratory compromise events, defined as absent, agonal, or inadequate respiration requiring emergency assisted ventilation and eliciting a hospital-wide or unit-based emergency response.…”

Presença da família no atendimento de emergência pediátrica hospitalar: elaboração e aplicação de um protocolo

“…A maioria dos estudos analisa as perspectivas de profissionais de saúde [9][10][11][12][13][14][15][16][17][18][19][20] . Além destes, também são encontrados artigos relacionados às percepções familiares sobre o tema 12,[21][22][23][24] ou que avaliem a dinâmica de atendimento de emergência com a presença da família 23,[25][26][27] . Estudos que analisam as percepções do paciente pediátrico em relação a temática não foram encontrados na literatura, provavelmente, em decorrência da vulnerabilidade da criança diante de situação emergencial, o que implica em questões éticas delicadas para a realização desse tipo de estudo.…”

“…Não há estudos disponíveis na literatura que indiquem a interrupção da assistência ao paciente pelo fato de sua família estar presente durante a realização de procedimentos invasivos e RCP 23,[25][26][27] .…”