Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes*

Parker, Margaret M.; Nuthall, Gabrielle; Brown, Calvin A.; Biagas, Katherine; Napolitano, Natalie; Polikoff, Lee; Simon, Dennis; Miksa, Michael; Gradidge, Eleanor; Lee, Jan Hau; Krishna, Ashwin; Téllez, David; Bird, Geoffrey L.; Rehder, Kyle J; Turner, David A.; Adu‐Darko, Michelle; Nett, Sholeen; Derbyshire, Ashley T.; Meyer, Keith; Giuliano, John S.; Owen, Erin B.; Sullivan, Janice E.; Tarquinio, Keiko M.; Kamat, Pradip; Sanders, Ronald C.; Pinto, Matthew; Bysani, G. Kris; Émériaud, Guillaume; Nagai, Yuki; McCarthy, Melissa A.; Walson, Karen; Vanderford, Paula A.; Lee, Anthony; Bain, Jesse; Skippen, Peter; Breuer, Ryan; Tallent, Sarah; Nadkarni, Vinay; Nishisaki, Akira

doi:10.1097/pcc.0000000000001074

Cited by 66 publications

(56 citation statements)

References 23 publications

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“…After adjusting for patient conditions and clinician levels, the odds ratio (OR) for these hemodynamic TIAEs was 1.83 (95% CI 1.34‐2.51) in tracheal intubations with hypoxemia (SpO2 < 80%) and 2.16 (95% CI 1.54‐3.04) in tracheal intubations with severe hypoxemia (SpO2 < 70%) . The occurrence of adverse TIAEs or oxygen desaturation was independently associated with a longer duration of mechanical ventilation in the ICU (+12%, 95% CI 4%‐21%), and the occurrence of severe TIAEs was independently associated with increased pediatric ICU mortality (OR 1.80, 95% CI 1.24‐2.60) . These data highlight the clinical significance of adverse TIAEs and hypoxemia during airway management.…”

Section: Airway Management In the Pediatric Icu Emergency Departmentmentioning

confidence: 99%

Normal and difficult airways in children: “What’s New”—Current evidence

Fiadjoe

Nishisaki

2020

Pediatric Anesthesia

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Background Pediatric difficult airway is one of the most challenging clinical situations. We will review new concepts and evidence in pediatric normal and difficult airway management in the operating room, intensive care unit, Emergency Department, and neonatal intensive care unit. Methods Expert review of the recent literature. Results Cognitive factors, teamwork, and communication play a major role in managing pediatric difficult airway. Earlier studies evaluated videolaryngoscopes in a monolithic way yielding inconclusive results regarding their effectiveness. There are, however, substantial differences among videolaryngoscopes particularly angulated vs. nonangulated blades which have different learning and use characteristics. Each airway device has strengths and weaknesses, and combining these devices to leverage both strengths will likely yield success. In the pediatric intensive care unit, emergency department and neonatal intensive care units, adverse tracheal intubation–associated events and hypoxemia are commonly reported. Specific patient, clinician, and practice factors are associated with these occurrences. In both the operating room and other clinical areas, use of passive oxygenation will provide additional laryngoscopy time. The use of neuromuscular blockade was thought to be contraindicated in difficult airway patients. Newer evidence from observational studies showed that controlled ventilation with or without neuromuscular blockade is associated with fewer adverse events in the operating room. Similarly, a multicenter neonatal intensive care unit study showed fewer adverse events in infants who received neuromuscular blockade. Neuromuscular blockade should be avoided in patients with mucopolysaccharidosis, head and neck radiation, airway masses, and external airway compression for anticipated worsening airway collapse with neuromuscular blocker administration. Conclusion Clinicians caring for children with difficult airways should consider new cognitive paradigms and concepts, leverage the strengths of multiple devices, and consider the role of alternate anesthetic approaches such as controlled ventilation and use of neuromuscular blocking drugs in select situations. Anesthesiologists can partner with intensive care and emergency department and neonatology clinicians to improve the safety of airway management in all clinical settings.

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Section: Airway Management In the Pediatric Icu Emergency Departmentmentioning

confidence: 99%

Normal and difficult airways in children: “What’s New”—Current evidence

Fiadjoe

Nishisaki

2020

Pediatric Anesthesia

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“…It is frequently associated with adverse events, and those adverse events are more likely to result in permanent disability or death than those which occur in the OR . Hypoxia and hypotension, in particular, have been reported in up to 1/3 of patients, are associated with poor neurological outcome, and are the strongest predictors of airway‐related death . More than 1 intubation attempt is the strongest predictor of hypoxia during the periintubation period .…”

Section: Introductionmentioning

confidence: 99%

“…1 Hypoxia and hypotension, in particular, have been reported in up to 1/3 of patients, 2 are associated with poor neurological outcome, and are the strongest predictors of airway-related death. 1,[3][4][5][6] More than 1 intubation attempt is the strongest predictor of hypoxia during the periintubation period. 7 As such, first pass success without hypoxia or hypotension should be the aim of all emergency airway management.…”

Section: Introductionmentioning

confidence: 99%

A quality improvement initiative to increase the safety of pediatric emergency airway management

Long

Cincotta

Grindlay

et al. 2017

Pediatric Anesthesia

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“…Even though only one in five of all children retrieved over the study period were intubated, this high‐risk group mandates specialist expertise. Intubation of critically ill children carries significant risk, including misplaced or dislodged endotracheal tubes, desaturation, hypotension and pneumothorax . Multiple attempts at endotracheal intubation are associated with an increased complication rate .…”

Section: Discussionmentioning

confidence: 99%

Endotracheal intubation by a specialised paediatric retrieval team

Glasheen

Holmes

Rampersad

et al. 2019

Emerg Medicine Australasia

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Objectives Intubation of critically ill children is an infrequent procedure, and is associated with significant risk. We set out to describe intubations carried out by the Children's Health Queensland Retrieval Service (CHQRS), with the intention to identify areas for improvement in the performance of intubation in the retrieval setting. Methods Paediatric patients undergoing transport while intubated were identified, and cases where intubation occurred after the arrival of the CHQRS team were examined. Results Over the study period of January 2015 to September 2018, 498 intubated retrievals were undertaken; 85 patients were intubated after the arrival of CHQRS; the age range was 1 day to 16.5 years (median 0.5, interquartile range [IQR] 0.11–3 years). The median weight was 6.2 kg (IQR 3.7–16.5 kg). The pathology requiring intubation included respiratory 36 (42.3%), sepsis 21 (24.7%), neurological 11 (12.9%) and trauma 7 (8.2%). A total of 470 of 498 (94.4%) of intubated patients were from regional referral or tertiary hospitals, 28 of 498 (5.6%) were from rural and remote facilities. Of 85 patients, 57 (67.1%) were intubated by CHQRS and 28 (32.9%) were intubated by a doctor from the referring facility. The CHQRS team was more likely to perform the intubation in smaller children (median weight 5.0 vs 9.9 kg, P = 0.03). The mean scene time was 2.8 h. The scene time was shorter if the intubation was performed by CHQRS (mean 2.6 h, median 2.5, IQR 1.8–3.3; median 3, IQR 2.2–3.9; P = 0.048). The scene time was shorter when the intubation was predicted from tasking information (2.6 vs 3.1 h; P = 0.03). Conclusion Paediatric endotracheal intubation is an infrequent procedure in our service. An airway registry could improve documentation and gather information to identify specific training requirements and areas for practice improvement.

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Relationship Between Adverse Tracheal Intubation Associated Events and PICU Outcomes*

Cited by 66 publications

References 23 publications

Normal and difficult airways in children: “What’s New”—Current evidence

Normal and difficult airways in children: “What’s New”—Current evidence

A quality improvement initiative to increase the safety of pediatric emergency airway management

Endotracheal intubation by a specialised paediatric retrieval team

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