A National Emergency Airway Registry for Children: Landscape of Tracheal Intubation in 15 PICUs
OBJECTIVES:: To characterize the landscape of process of care and safety outcomes for tracheal intubation across pediatric intensive care units BACKGROUND:: Procedural process of care and safety outcomes of tracheal intubation across pediatric intensive care units has not been described. We hypothesize that the novel National Emergency Airway Registry for Children registry is a feasible tool to capture tracheal intubation process of care and outcomes. DESIGN:: Prospective, descriptive. SETTING:: Fifteen academic PICUs in North America. PATIENTS:: Critically ill children requiring tracheal intubation in PICUs. INTERVENTIONS:: Tracheal intubation quality improvement data were prospectively collected for all initial tracheal intubation in 15 PICUs from July 2010 to December 2011 using the National Emergency Airway Registry for Children tool with explicit site-specific compliance plans and operational definitions including adverse tracheal intubation associated events. MEASUREMENT AND MAIN RESULTS:: One thousand seven hundred fifteen tracheal intubation encounters were reported (averaging 1/3.4 days, or 1/86 bed days). Ninety-eight percent of primary tracheal intubation were successful; 86% were successful with less than or equal to two attempts. First attempt was by pediatric residents in 23%, pediatric critical care fellows in 41%, and critical care attending physicians in 13%: first attempt success rate was 62%, first provider success rate was 79%. The first method was oral intubation in 1,659 (98%) and nasal in 55 (2%). Direct laryngoscopy was used in 96%. Ninety percent of tracheal intubation were with cuffed tracheal tubes. Adverse tracheal intubation associated events were reported in 20% of intubations (n = 372), with severe tracheal intubation associated events in 6% (n = 115). Esophageal intubation with immediate recognition was the most common tracheal intubation associated events (n = 167, 9%). History of difficult airway, diagnostic category, unstable hemodynamics, and resident provider as first airway provider were associated with occurrence of tracheal intubation associated events. Severe tracheal intubation associated events were associated with diagnostic category and pre-existing unstable hemodynamics. Elective tracheal intubation status was associated with fewer severe tracheal intubation associated events. CONCLUSIONS:: National Emergency Airway Registry for Children was feasible to characterize PICU tracheal intubation procedural process of care and safety outcomes. Self-reported adverse tracheal intubation associated events occurred frequently and were associated with patient, provider, and practice characteristics.
- 0Comments 0Citations
- [Show abstract] [Hide abstract] ABSTRACT: Although the use of an anesthesiology "airway" rotation to train the nonanesthesiologist is commonly employed, little data exist on the utility, clinical exposure, and outcomes of these programs. A prospectively collected observational dataset of airway procedures completed by trainees in a 4-week, anesthesiology-based, airway rotation at an academic, level-1 trauma center from July 2010 to September 2012 was reviewed. Prospectively defined data points were collected through an online data tool and included patient demographics, location, date, best laryngoscopic view, and attempt details. At the authors' institution, an attending trauma anesthesiologist is present for all intubation attempts. The primary outcome was first-attempt success. A total of 4,282 self-reported, airway procedures were identified. The median number of procedures performed was 50.4 ± 13.2 (range, 20 to 93; 25th quartile = 41; 75th quartile = 57). Multivariate logistic regression analysis modeling of first-attempt success rate identified two independent predictors of success: rotation week (odds ratio, 1.42; 95% CI, 1.32 to 1.61; P < 0.0001) and number of previous intubation attempts before rotation (odds ratio, 1.23; 95% CI, 1.03 to 1.46; P = 0.02. In addition, the percentage of cases with a self-reported laryngoscopic grade 1 view increased significantly from 61 to 74% (P = 0.015) from week 1 to week 4 of the rotation. An anesthesiology-based program for airway training of nonanesthesiologists demonstrates improved self-reported, perceived first-attempt success over the course of training with improved ability to visualize glottic structures.0Comments 3Citations
- 0Comments 1Citation