Outcomes and follow-up for children intubated in an adult-based community hospital system: A retrospective chart review

Abstract

Objectives Emergency intubation is a high-risk procedure in children. Studies describing intubation practices in locations other than pediatric centres are scarce and varied. This study described pediatric intubations in adult-based community emergency departments (EDs) and determined what factors were associated with intubated-related adverse events (AEs) and described outcomes of children transferred to a quaternary care pediatric institution. Methods This is a retrospective review of data collected between January 2006 and March 2017 at Lakeridge Health and Hospital for Sick Children (SickKids). Patients were <18 years and intubated in Lakeridge Health EDs; those intubated prior to ED arrival were excluded. Primary outcomes were intubation first-pass success (FPS) and AEs secondary to intubation. Results Patients ( n = 121) were analyzed, and median (interquartile range (IQR)) age was 3.7 (0.4–14.3) years. There were 76 (62.8%) FPS, with no difference between pediatricians ( n = 25, 23%) or anaesthetists ( n = 12, 11%), versus all other providers (paramedic n = 13 (12%), ED physician n = 37 (34%), respiratory therapist n = 20 (18%), transfer team n = 2 (2%)). The proportion of AEs was 24 (19.8%, n = 21 minor, n = 3 major), with no significant difference between pediatricians or anaesthetists versus all other providers. Data from 68 children transferred to SickKids were available, with the majority extubated within a short median (IQR) time of admission, 1.2 (0.29–3.8) days. Conclusions Pediatric intubations were rare in a Canadian adult-based community hospital system. Most intubations demonstrated FPS with relatively few AEs and no significant differences between health provider type. Future investigations should utilize multi-centred data to inform strategies suited for organizations’ unique practice cultures, including training programs.

Benefits of Cardiac Rehabilitation in Cardio-Renal Patients With Heart Failure With Reduced Ejection Fraction

“…In the present study, we also demonstrated a significant improvement in V˙O 2 at VT1, maximal workload, and duration of physical exercise which could potentially improve the QOL of patients with HFrEF and CKD. Improvement in QOL after CR has been widely demonstrated in various cardiac conditions including HF,9,11,47 or with comorbidities 48,49. The benefits of exercise on QOL are also well demonstrated in patients with CKD 26,44,45.…”

“…Improvement in QOL after CR has been widely demonstrated in various cardiac conditions including HF, 9,11,47 or with comorbidities. 48,49 The benefits of exercise on QOL are also well demonstrated in patients with CKD. 26,44,45 However, to the best of our knowledge, no study has evaluated the benefits of CR on QOL in patients with CRS.…”