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Effect of Location on Tracheal Intubation Safety in Cardiac Disease—Are Cardiac ICUs Safer?
- 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.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
Databases, Factual
Heart Diseases
Heart disease
Critical Illness
health care facilities, manpower, and services
medicine.medical_treatment
030204 cardiovascular system & hematology
Intensive Care Units, Pediatric
Critical Care and Intensive Care Medicine
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Interquartile range
030225 pediatrics
Intubation, Intratracheal
medicine
Humans
Intubation
Oximetry
Practice Patterns, Physicians'
Child
Adverse effect
Retrospective Studies
business.industry
Tracheal intubation
Infant, Newborn
Infant
Retrospective cohort study
Odds ratio
medicine.disease
Quality Improvement
Child, Preschool
Pediatrics, Perinatology and Child Health
Emergency medicine
cardiovascular system
Female
business
Cohort study
Subjects
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