Abstract 157: Airway Rescue (Tracheal Intubation) Process of Care and Safety Across Diverse Pediatric ICUs: A Report from the National Emergency Airway Registry for Children---“NEAR4KIDS”
Objective: To describe airway rescue practices in a cross-sectional sample of academic pediatric ICUs (PICUs). We hypothesize that larger PICUs with >25 beds (L) will have less intubations requiring >2 attempts and less adverse tracheal intubation associated events (TIAEs) occurrences compared to smaller PICUs (S).
Method: A multicenter database to capture airway rescue intubation procedures in PICUs across the nation was developed: National Emergency Airway Registry for Children (NEAR4KIDS). The incidence of airway rescue, process of care variance (multiple attempts: intubation course requiring>2 attempts), and safety outcomes (TIAEs) were reported. Data compliance was strictly monitored by a compliance plan submitted by each site. Analysis by Fisher's exact test and multivariate logistic regression adjusting for patient age, gender and risk of mortality (PIM2), with a two-sided alpha=0.05 considered significant.
Result: Eleven PICUs (5 L, 6 S) reported 475 intubation courses (L: 288, S : 187) in 457 patients (L: 277, S: 180). Patient age, gender or illness severity did not differ between L vs. S. Resident trainee involvement as the first laryngoscopist was not significantly different (L: 35.8% vs. S: 30.0%, p=0.2) Large PICUs had more intubation courses with multiple attempts (L: 20.1% vs. S: 12.3%, adjusted OR 1.4 [95% CI: 0.76-2.5], p=0.30), more intubation courses with TIAEs (L: 34.0% vs. S: 20.9%, adjusted OR 2.4 [95% CI: 1.4-4.1], p=0.002), and more severe TIAEs (L: 11.1 % vs. S: 7.5%, adjusted OR 3.5 [95% CI:1.2-10.1], p=0.022). 11/475 (2.3%) intubation courses led to CPR and 3/475 (0.6%) resulted in deaths.
Conclusion: Airway rescue (Tracheal intubation) in large (>25 beds) PICUs, compared with smaller (≤25 beds) PICUs has higher incidence of adverse TIAEs, even when adjusted for patient level factors. Tracheal intubation in PICUs is associated with subsequent cardiac arrest in 2.3%.
- © 2011 by American Heart Association, Inc.