Safety of tracheal intubation in the presence of cardiac disease in paediatric ICUs

Eleanor A Gradidge¹, Adnan Bakar², David Tellez¹, Michael Ruppe³, Sarah Tallent⁴, Geoffrey Bird⁵, Natasha Lavin⁶, Anthony Lee⁷, Vinay Nadkarni⁸, Michelle Adu-Darko⁹, Jesse Bain¹⁰, Katherine Biagas¹¹, Aline Branca¹, Ryan K Breuer¹², Calvin Brown¹³, Kris Bysani¹⁴, Guillaume Emeriaud¹⁵, Sandeep Gangadharan², John S Giuliano¹⁶, Joy D Howell¹⁷, Conrad Krawiec¹⁸, Jan Hau Lee¹⁹, Simon Li²⁰, Keith Meyer²¹, Michael Miksa²², Natalie Napolitano⁶, Sholeen Nett²³, Gabrielle Nuthall²⁴, Alberto Orioles²⁵, Erin B Owen³, Margaret M Parker²⁶, Simon Parsons²⁷, Lee A Polikoff²⁸, Kyle Rehder⁴, Osamu Saito²⁹, Ron C Sanders³⁰, Asha Shenoi³¹, Dennis W Simon³², Peter W Skippen³³, Keiko Tarquinio³⁴, Anne Thompson³², Iris Toedt-Pingel³⁵, Karen Walson³⁶, Akira Nishisaki⁸; For National Emergency Airway Registry for Children (NEARKIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

Affiliations

¹ 1Division of Pediatric Critical Care,Phoenix Children's Hospital,Phoenix,AZ,USA.
² 2Pediatric Cardiology,Cohen Children's Medical Center,Northwell Health System,Hofstra School of Medicine,New Hyde Park,NY,USA.
³ 3Department of Pediatrics,Division of Critical Care Medicine,University of Louisville School of Medicine,Norton Children's Hospital,Louisville,KY,USA.
⁴ 4Division of Pediatric Critical Care Medicine,Duke University Hospital,Durham,NC,USA.
⁵ 5Division of Cardiac Critical Care Medicine,The Children's Hospital of Philadelphia,Philadelphia,PA,USA.
⁶ 6Respiratory Care Department,The Children's Hospital of Philadelphia,Philadelphia,PA,USA.
⁷ 7Department of Pediatrics,Ohio State University College of Medicine,Nationwide Children's Hospital,Columbus,OH,USA.
⁸ 8Department of Anesthesiology and Critical Care Medicine,The Children's Hospital of Philadelphia,Philadelphia,PA,USA.
⁹ 9Department of Pediatrics,Division of Pediatric Critical Care,University of Virginia Children's Hospital,Charlottesville,VA,USA.
¹⁰ 10Department of Pediatrics,Division of Critical Care Medicine,Children's Hospital of Richmond at VCU,Richmond,VA,USA.
¹¹ 11Division of Pediatric Critical Care Medicine,New York Presbyterian Hospital,Columbia University Medical Center,New York,NY,USA.
¹² 12Division of Critical Care,UBMD Pediatrics,Women and Children's Hospital of Buffalo,University at Buffalo,Buffalo,NY,USA.
¹³ 13Department of Emergency Medicine,Harvard Medical School,Brigham and Women's Hospital,Boston,MA,USA.
¹⁴ 14Pediatric Acute Care Associates of North Texas PLLC,Medical City Children's Hospital,Dallas,TX,USA.
¹⁵ 15Department of Pediatrics,CHU Sainte Justine,Université de Montréal,Montreal,QC,Canada.
¹⁶ 16Department of Pediatrics,Division of Critical Care Medicine,Yale University School of Medicine,New Haven,CT,USA.
¹⁷ 17Department of Pediatrics,Weill Cornell Medical College,New York,NY,USA.
¹⁸ 18Division of Pediatrics Critical Care Medicine,Department of Pediatrics and Public Health Science,Penn State Hershey Children's Hospital,Hershey,PA,USA.
¹⁹ 19KK Women's and Children's Hospital,Singapore,Singapore.
²⁰ 20Department of Pediatrics,Division of Critical Care Medicine,New York Medical College,Maria Fareri Children's Hospital,Valhalla,NY,USA.
²¹ 21Nicklaus Children's Hospital,Miami Children's Health System,Miami,FL,USA.
²² 22Department of Pediatric Critical Care,Children's Hospital at Montefiore,Albert Einstein College of Medicine,Bronx,NY,USA.
²³ 23Department of Pediatrics,Section of Pediatric Critical Care Medicine,Dartmouth-Hitchcock Medical Center,Lebanon,NH,USA.
²⁴ 24Paediatric Intensive Care Unit,Starship Children's Hospital,Auckland,New Zealand.
²⁵ 25Children's Respiratory and Critical Care Specialist,Children's Hospitals and Clinics of Minnesota,Minneapolis,MN,USA.
²⁶ 26Department of Pediatrics,Stony Brook Children's Hospital,Stony Brook,NY,USA.
²⁷ 27Department of Critical Care,Alberta Children's Hospital,Calgary,AB,Canada.
²⁸ 28Division of Pediatric Critical Care Medicine,The Warren Alpert School of Medicine at Brown University,Providence,RI,USA.
²⁹ 29Department of Pediatric Emergency and Critical Care Medicine,Tokyo Metropolitan Children's Medical Center,Tokyo,Japan.
³⁰ 30Section of Pediatric Critical Care,Department of Pediatrics,University of Arkansas College of Medicine,Little Rock,AR,USA.
³¹ 31Department of Pediatrics,Division of Pediatric Critical Care,Kentucky Children's Hospital,University of Kentucky College of Medicine,Lexington,KY,USA.
³² 32University of Pittsburgh School of Medicine,Pittsburgh,PA,USA.
³³ 33Pediatric Intensive Care Unit,BC Children's Hospital,Vancouver,BC,Canada.
³⁴ 34Department of Pediatrics,Division of Pediatric Critical Care Medicine,Emory University School of Medicine,Atlanta,GA,USA.
³⁵ 35Pediatric Critical Care,University of Vermont College of Medicine,Burlington,VT,USA.
³⁶ 36Department of Critical Care,Children's Healthcare of Atlanta at Scottish Rite,Atlanta,GA,USA.

PMID: 29690950
DOI: 10.1017/S1047951118000495

Multicenter Study

Safety of tracheal intubation in the presence of cardiac disease in paediatric ICUs

Eleanor A Gradidge et al. Cardiol Young. 2018 Jul.

. 2018 Jul;28(7):928-937.

doi: 10.1017/S1047951118000495. Epub 2018 Apr 25.

Authors

Affiliations

¹ 1Division of Pediatric Critical Care,Phoenix Children's Hospital,Phoenix,AZ,USA.
² 2Pediatric Cardiology,Cohen Children's Medical Center,Northwell Health System,Hofstra School of Medicine,New Hyde Park,NY,USA.
³ 3Department of Pediatrics,Division of Critical Care Medicine,University of Louisville School of Medicine,Norton Children's Hospital,Louisville,KY,USA.
⁴ 4Division of Pediatric Critical Care Medicine,Duke University Hospital,Durham,NC,USA.
⁵ 5Division of Cardiac Critical Care Medicine,The Children's Hospital of Philadelphia,Philadelphia,PA,USA.
⁶ 6Respiratory Care Department,The Children's Hospital of Philadelphia,Philadelphia,PA,USA.
⁷ 7Department of Pediatrics,Ohio State University College of Medicine,Nationwide Children's Hospital,Columbus,OH,USA.
⁸ 8Department of Anesthesiology and Critical Care Medicine,The Children's Hospital of Philadelphia,Philadelphia,PA,USA.
⁹ 9Department of Pediatrics,Division of Pediatric Critical Care,University of Virginia Children's Hospital,Charlottesville,VA,USA.
¹⁰ 10Department of Pediatrics,Division of Critical Care Medicine,Children's Hospital of Richmond at VCU,Richmond,VA,USA.
¹¹ 11Division of Pediatric Critical Care Medicine,New York Presbyterian Hospital,Columbia University Medical Center,New York,NY,USA.
¹² 12Division of Critical Care,UBMD Pediatrics,Women and Children's Hospital of Buffalo,University at Buffalo,Buffalo,NY,USA.
¹³ 13Department of Emergency Medicine,Harvard Medical School,Brigham and Women's Hospital,Boston,MA,USA.
¹⁴ 14Pediatric Acute Care Associates of North Texas PLLC,Medical City Children's Hospital,Dallas,TX,USA.
¹⁵ 15Department of Pediatrics,CHU Sainte Justine,Université de Montréal,Montreal,QC,Canada.
¹⁶ 16Department of Pediatrics,Division of Critical Care Medicine,Yale University School of Medicine,New Haven,CT,USA.
¹⁷ 17Department of Pediatrics,Weill Cornell Medical College,New York,NY,USA.
¹⁸ 18Division of Pediatrics Critical Care Medicine,Department of Pediatrics and Public Health Science,Penn State Hershey Children's Hospital,Hershey,PA,USA.
¹⁹ 19KK Women's and Children's Hospital,Singapore,Singapore.
²⁰ 20Department of Pediatrics,Division of Critical Care Medicine,New York Medical College,Maria Fareri Children's Hospital,Valhalla,NY,USA.
²¹ 21Nicklaus Children's Hospital,Miami Children's Health System,Miami,FL,USA.
²² 22Department of Pediatric Critical Care,Children's Hospital at Montefiore,Albert Einstein College of Medicine,Bronx,NY,USA.
²³ 23Department of Pediatrics,Section of Pediatric Critical Care Medicine,Dartmouth-Hitchcock Medical Center,Lebanon,NH,USA.
²⁴ 24Paediatric Intensive Care Unit,Starship Children's Hospital,Auckland,New Zealand.
²⁵ 25Children's Respiratory and Critical Care Specialist,Children's Hospitals and Clinics of Minnesota,Minneapolis,MN,USA.
²⁶ 26Department of Pediatrics,Stony Brook Children's Hospital,Stony Brook,NY,USA.
²⁷ 27Department of Critical Care,Alberta Children's Hospital,Calgary,AB,Canada.
²⁸ 28Division of Pediatric Critical Care Medicine,The Warren Alpert School of Medicine at Brown University,Providence,RI,USA.
²⁹ 29Department of Pediatric Emergency and Critical Care Medicine,Tokyo Metropolitan Children's Medical Center,Tokyo,Japan.
³⁰ 30Section of Pediatric Critical Care,Department of Pediatrics,University of Arkansas College of Medicine,Little Rock,AR,USA.
³¹ 31Department of Pediatrics,Division of Pediatric Critical Care,Kentucky Children's Hospital,University of Kentucky College of Medicine,Lexington,KY,USA.
³² 32University of Pittsburgh School of Medicine,Pittsburgh,PA,USA.
³³ 33Pediatric Intensive Care Unit,BC Children's Hospital,Vancouver,BC,Canada.
³⁴ 34Department of Pediatrics,Division of Pediatric Critical Care Medicine,Emory University School of Medicine,Atlanta,GA,USA.
³⁵ 35Pediatric Critical Care,University of Vermont College of Medicine,Burlington,VT,USA.
³⁶ 36Department of Critical Care,Children's Healthcare of Atlanta at Scottish Rite,Atlanta,GA,USA.

PMID: 29690950
DOI: 10.1017/S1047951118000495

Abstract

IntroductionChildren with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.Materials and methodsWe sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.

Results: A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.

Conclusions: The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.

Keywords: Tracheal intubation; cardiac arrest; cardiac disease; paediatric ICU; quality improvement; safety.

PubMed Disclaimer

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

R18 HS024511/HS/AHRQ HHS/United States

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Safety of tracheal intubation in the presence of cardiac disease in paediatric ICUs

Affiliations

Safety of tracheal intubation in the presence of cardiac disease in paediatric ICUs

Authors

Affiliations

Abstract

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources