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Effect of Location on Tracheal Intubation Safety in Cardiac Disease—Are Cardiac ICUs Safer?

Authors :
Geoffrey L. Bird
Eleanor Gradidge
Simon J. Parsons
Paula A. Vanderford
Calvin A. Brown
Dennis W. Simon
Keith Meyer
Asha Shenoi
John S. Giuliano
Simon Li
Guillaume Emeriaud
Adnan Bakar
Sandeep Gangadharan
Jan Hau Lee
Michael Miksa
Ronald C. Sanders
Iris Toedt-Pingel
Michelle Adu-Darko
Ira M. Cheifitz
Sarah Tallent
Natalie Napolitano
Gabrielle Nuthall
Lee A. Polikoff
Sholeen Nett
Anthony Lee
Margaret M. Parker
David Tellez
Erin B. Owen
Karen Walson
Conrad Krawiec
Joy D. Howell
G. Kris Bysani
Ryan Breuer
Peter Skippen
Akira Nishisaki
Osamu Saito
Alberto Orioles
Ann E. Thompson
Keiko M. Tarquinio
Michael Ruppe
Aline Branca
Jesse Bain
Vinay M. Nadkarni
Kyle J Rehder
Katherine Biagas
Natasha Lavin
Source :
Pediatric Critical Care Medicine. 19:218-227
Publication Year :
2018
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2018.

Abstract

OBJECTIVES Evaluate differences in tracheal intubation-associated events and process variances (i.e., multiple intubation attempts and oxygen desaturation) between pediatric cardiac ICUs and noncardiac PICUs in children with underlying cardiac disease. DESIGN Retrospective cohort study using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children). SETTING Thirty-six PICUs (five cardiac ICUs, 31 noncardiac ICUs) from July 2012 to March 2016. PATIENTS Children with medical or surgical cardiac disease who underwent intubation in an ICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Our primary outcome was the rate of any adverse tracheal intubation-associated event. Secondary outcomes were severe tracheal intubation-associated events, multiple tracheal intubation attempt rates, and oxygen desaturation. There were 1,502 tracheal intubations in children with underlying cardiac disease (751 in cardiac ICUs, 751 in noncardiac ICUs) reported. Cardiac ICUs and noncardiac ICUs had similar proportions of patients with surgical cardiac disease. Patients undergoing intubation in cardiac ICUs were younger (median age, 1 mo [interquartile range, 0-6 mo]) compared with noncardiac ICUs (median 3 mo [interquartile range, 1-11 mo]; p < 0.001). Tracheal intubation-associated event rates were not different between cardiac ICUs and noncardiac ICUs (16% vs 19%; adjusted odds ratio, 0.74; 95% CI, 0.54-1.02; p = 0.069). However, in a sensitivity analysis comparing cardiac ICUs with mixed ICUs (i.e., ICUs caring for children with either general pediatric or cardiac diseases), cardiac ICUs had decreased odds of adverse events (adjusted odds ratio, 0.71; 95% CI, 0.52-0.97; p = 0.033). Rates of severe tracheal intubation-associated events and multiple attempts were similar. Desaturations occurred more often during intubation in cardiac ICUs (adjusted odds ratio, 1.61; 95% CI, 1.04-1.15; p = 0.002). CONCLUSIONS In children with underlying cardiac disease, rates of adverse tracheal intubation-associated events were not lower in cardiac ICUs as compared to noncardiac ICUs, even after adjusting for differences in patient characteristics and care models.

Details

ISSN :
15297535
Volume :
19
Database :
OpenAIRE
Journal :
Pediatric Critical Care Medicine
Accession number :
edsair.doi.dedup.....f1ae0a8e24305ddaf4530733af084725
Full Text :
https://doi.org/10.1097/pcc.0000000000001422