Tracheal Intubation by Advanced Practice Registered Nurses in Pediatric Critical Care: Retrospective Study From the National Emergency Airway for Children Registry (2015-2019)

Danielle M Van Damme¹, Emily M McRae^{1

2}, Sharon Y Irving^{3

4}, Serena P Kelly⁵, Keiko M Tarquinio⁶, John S Giuliano Jr⁷, Michael D Ruppe^{1

8}, Krista L Kierys⁹, Ryan K Breuer¹⁰, Simon J Parsons¹¹, Palen P Mallory¹², Asha N Shenoi¹³, Kelly A Swain¹⁴, Lee A Polikoff¹⁵, Anthony Lee¹⁶, Michelle A Adu-Darko¹⁷, Natalie Napolitano¹⁸, Justine Shults¹⁹, Akira Nishisaki^{20

21}, John W Berkenbosch^{1

8}; National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)

Affiliations

¹ "Just For Kids" Critical Care Center, Norton Children's Hospital, Louisville, KY.
² School of Nursing, University of Louisville, Louisville, KY.
³ School of Nursing, University of Pennsylvania, Philadelphia, PA.
⁴ Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia PA.
⁵ Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR.
⁶ Pediatric Critical Care Medicine, Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, Atlanta, GA.
⁷ Pediatric Critical Care Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
⁸ Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY.
⁹ Pediatric Critical Care, Penn State Health, Hershey, PA.
¹⁰ Critical Care Medicine, Oishei Children's Hospital, University at Buffalo, Buffalo, NY.
¹¹ Section of Critical Care, Alberta Children's Hospital, Calgary, AB, Canada.
¹² Division of Pediatric Critical Care, Department of Pediatrics, Duke University, Durham, NC.
¹³ Pediatric Critical Care, Department of Pediatrics, University of Kentucky, Lexington, KY.
¹⁴ Pediatric Critical Care/Pediatric Cardiac ICU, Duke University, Durham, NC.
¹⁵ Pediatric Critical Care Medicine, The Warren Alpert Medical School of Brown University, Providence, RI.
¹⁶ Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.
¹⁷ Pediatric Critical Care, University of Virginia, Charlottesville, VA.
¹⁸ Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA.
¹⁹ Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
²⁰ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
²¹ Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

PMID: 37882620
PMCID: PMC10842935
DOI: 10.1097/PCC.0000000000003386

Tracheal Intubation by Advanced Practice Registered Nurses in Pediatric Critical Care: Retrospective Study From the National Emergency Airway for Children Registry (2015-2019)

Danielle M Van Damme et al. Pediatr Crit Care Med. 2024.

. 2024 Feb 1;25(2):139-146.

doi: 10.1097/PCC.0000000000003386. Epub 2023 Oct 26.

Authors

Affiliations

¹ "Just For Kids" Critical Care Center, Norton Children's Hospital, Louisville, KY.
² School of Nursing, University of Louisville, Louisville, KY.
³ School of Nursing, University of Pennsylvania, Philadelphia, PA.
⁴ Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia PA.
⁵ Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR.
⁶ Pediatric Critical Care Medicine, Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, Atlanta, GA.
⁷ Pediatric Critical Care Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
⁸ Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY.
⁹ Pediatric Critical Care, Penn State Health, Hershey, PA.
¹⁰ Critical Care Medicine, Oishei Children's Hospital, University at Buffalo, Buffalo, NY.
¹¹ Section of Critical Care, Alberta Children's Hospital, Calgary, AB, Canada.
¹² Division of Pediatric Critical Care, Department of Pediatrics, Duke University, Durham, NC.
¹³ Pediatric Critical Care, Department of Pediatrics, University of Kentucky, Lexington, KY.
¹⁴ Pediatric Critical Care/Pediatric Cardiac ICU, Duke University, Durham, NC.
¹⁵ Pediatric Critical Care Medicine, The Warren Alpert Medical School of Brown University, Providence, RI.
¹⁶ Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH.
¹⁷ Pediatric Critical Care, University of Virginia, Charlottesville, VA.
¹⁸ Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA.
¹⁹ Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
²⁰ Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
²¹ Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

PMID: 37882620
PMCID: PMC10842935
DOI: 10.1097/PCC.0000000000003386

Abstract

Objectives: To describe tracheal intubation (TI) practice by Advanced Practice Registered Nurses (APRNs) in North American PICUs, including rates of TI-associated events (TIAEs) from 2015 to 2019.

Design/setting: Retrospective study using the National Emergency Airway Registry for Children with all TIs performed in PICU and pediatric cardiac ICU between January 2015 and December 2019. The primary outcome was first attempt TI success rate. Secondary outcomes were TIAEs, severe TIAEs, and hypoxemia.

Subjects: Critically ill children requiring TI in a PICU or pediatric cardiac ICU.

Interventions: None.

Measurements and main results: Among 11,012 TIs, APRNs performed 1,626 (14.7%). Overall, TI by APRNs, compared with other clinicians, occurred less frequently in patients with known difficult airway (11.1% vs. 14.3%; p < 0.001), but more frequently in infants younger than 1 year old (55.9% vs. 44.4%; p < 0.0001), and in patients with cardiac disease (26.3% vs. 15.9%; p < 0.0001).There was lower odds of success in first attempt TI for APRNs vs. other clinicians (adjusted odds ratio, 0.70; 95% CI, 0.62-0.79). We failed to identify a difference in rates of TIAE, severe TIAE, and oxygen desaturation events for TIs by APRNs compared with other clinicians. The TI first attempt success rate improved with APRN experience (< 1 yr: 54.2%, 1-5 yr: 59.4%, 6-10 yr: 67.6%, > 10 yr: 63.1%; p = 0.021).

Conclusions: TI performed by APRNs was associated with lower odds of first attempt success when compared with other ICU clinicians although there was no appreciable difference in procedural adverse events. There appears to be a positive relationship between experience and success rates. These data suggest there is an ongoing need for opportunities to build on TI competency with APRNs.

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Conflict of interest statement

Dr. Polikoff received funding from Novavax. Drs. Napolitano’s and Shults’s institutions received funding from the Agency for Healthcare Research and Quality (AHRQ) (R18HS024511). Dr. Napolitano’s institution received funding from Drager, Timpel, Respironics, Actuated Medical, and Vero-Biotech. Dr. Shults received support for article research from the AHRQ (R18HS024511). Dr. Berkenbosch received funding from Pfizer. Dr. Nishisaki’s institution received funding from the AHRQ, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Chiesi USA; she received support for article research from the AHRQ. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

**Figure 1.**
Advanced Practice Registered Nurse clinical experience and procedural success and safety outcomes TIAE denotes tracheal intubation associated events.

See this image and copyright information in PMC

References

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Tracheal Intubation by Advanced Practice Registered Nurses in Pediatric Critical Care: Retrospective Study From the National Emergency Airway for Children Registry (2015-2019)

Affiliations

Tracheal Intubation by Advanced Practice Registered Nurses in Pediatric Critical Care: Retrospective Study From the National Emergency Airway for Children Registry (2015-2019)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources