Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments.
| Title: | Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. |
|---|---|
| Authors: | To YH; Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.; Ong YG; Department of Emergency Medicine, KK Women's and Children's Hospital, SingHealth, Singapore City, Singapore.; Chong SL; Department of Emergency Medicine, KK Women's and Children's Hospital, SingHealth, Singapore City, Singapore.; Ang PH; Accident & Emergency Department, Changi General Hospital, SingHealth, Singapore City, Singapore.; Bte Zakaria ND; Department of Emergency Medicine, Singapore General Hospital, SingHealth, Singapore City, Singapore.; Lee KP; Department of Emergency Medicine, KK Women's and Children's Hospital, SingHealth, Singapore City, Singapore.; Pek JH; Department of Emergency Medicine, Sengkang General Hospital, SingHealth, Singapore City, Singapore. |
| Source: | Paediatric anaesthesia [Paediatr Anaesth] 2021 Jun; Vol. 31 (6), pp. 713-719. Date of Electronic Publication: 2021 Apr 11. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Arnette-Blackwell Country of Publication: France NLM ID: 9206575 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1460-9592 (Electronic) Linking ISSN: 11555645 NLM ISO Abbreviation: Paediatr Anaesth Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Paris, France : Arnette-Blackwell, c1991- |
| MeSH Terms: | Intubation, Intratracheal* ; Laryngoscopy*; Adolescent ; Child ; Child, Preschool ; Emergencies ; Emergency Service, Hospital ; Humans ; Retrospective Studies |
| Abstract: | Background: Intubation is a life-saving intervention at the Emergency Department (ED). However, general and pediatric EDs may vary in their preparedness to manage children with airway emergencies.; Aims: We aimed to compare rates of first-pass intubation and adverse tracheal intubation-associated events between general and pediatric EDs.; Methods: A retrospective review of medical records was conducted at a pediatric ED and three general EDs from January 1, 2015, to December 31, 2018. Information about the intubation process involving pediatric patients (less than 16 years old), as well as eventual outcomes of first-pass intubation and adverse tracheal intubation-associated events were collected and analyzed.; Results: There were 180 pediatric intubations, of which 115 (63.9%) were performed in pediatric ED. The median age was 2 years old (interquartile range 0-6). Intubation was most commonly performed for patients with cardiac arrest (88, 48.9%). Direct laryngoscopy was used in 178 (98.9%) cases and uncuffed tube was used in 135 (75.0%) cases. Apneic oxygenation was performed in 26 (14.4%) cases-all in pediatric ED. Intubation was predominantly performed by senior clinicians (162, 90.0%). Overall, intubation was performed successfully in 175 (97.2%) cases, with a first-pass intubation rate of 82.2% which was similar between pediatric (96, 83.5%) and general EDs (52, 80%) (Odds ratio [OR] 1.26, 95% confidence interval [CI] 0.58 to 2.76, p = .558). There were 68 adverse tracheal intubation-associated events with right mainstem intubation being the most common (23, 12.8%). Pediatric EDs (44, 38.3%) had a higher rate of adverse tracheal intubation-associated events than general EDs (15, 23.1%) (OR 2.07, 95% CI 1.04 to 4.11; p = .037).; Conclusions: Differences exist in intubation outcomes between pediatric and general EDs. Quality improvement efforts should focus on standardizing intubation practices across both pediatric and general EDs.; (© 2021 John Wiley & Sons Ltd.) |
| References: | Long E, Sabato S, Babl FE. Endotracheal intubation in the pediatric Emergency Department. Paediatr Anaesth. 2014;24:1204-1211.; Pallin DJ, Dwyer RC, Walls RM, Brown CA 3rd, NEAR III Investigators. Techniques and trends, success rates, and adverse events in Emergency Department pediatric intubations: a report from the National Emergency Airway Registry. Ann Emerg Med. 2016;67:610-615.e1.; Matettore A, Ramnarayan P, Jones A, et al. Adverse tracheal intubation-associated events in pediatric patients at nonspecialist centers: a multicenter prospective observational study. Pediatr Crit Care Med. 2019;20:518-526.; Yurtseven A, Turan C, Kılınç MA, Ulaş SE. Frequency and outcomes of endotracheal intubation in the pediatric Emergency Department. Turk J Pediatr. 2017;59:524-530.; Oglesby AJ, Graham CA, Beard D, McKeown DW. Paediatric intubation in Scottish Emergency Departments. Paediatr Anaesth. 2003;13:589-595.; Goto T, Gibo K, Hagiwara Y, et al. Factors associated with first-pass success in pediatric intubation in the Emergency Department. West J Emerg Med. 2016;17:129-134.; Ames SG, Davis BS, Marin JR, et al. Emergency Department pediatric readiness and mortality in critically ill children. Pediatrics. 2019;144:e20190568.; Remick K, Gausche-Hill M, Joseph MM, et al. Pediatric readiness in the Emergency Department. Ann Emerg Med. 2018;72:e123-e136.; Jain PN, Choi J, Katyal C. Pediatric care in the nonpediatric Emergency Department: provider perspectives. Hosp Pediatr. 2019;9:216-219.; Foglia EE, Ades A, Napolitano N, Leffelman J, Nadkarni V, Nishisaki A. Factors associated with adverse events during tracheal intubation in the NICU. Neonatology. 2015;108:23-29.; Rinderknecht AS, Mittiga MR, Meinzen-Derr J, Geis GL, Kerrey BT. Factors associated with oxyhemoglobin desaturation during rapid sequence intubation in a pediatric Emergency Department: findings from multi-variable analyses of video review data. Acad Emerg Med. 2015;22:431-440.; Pek JH, Ong GY. Emergency intubations in a high-volume pediatric Emergency Department. Pediatr Emerg Care. 2018;34:852-856.; Pek JH, Kang HM, Wong E. Improving apneic oxygenation use for rapid sequence intubation in an Emergency Department. Trends Anaesth. 2017;13:25-31.; Pek JH, Tan HC, Shen G, Ong YKG. Apneic oxygenation for emergency intubations in the pediatric Emergency Department - a quality improvement initiative. Pediatr Qual Saf. 2020;5:e255.; Parker MM, Nuthall G, Brown C 3rd, et al. Relationship between adverse tracheal intubation associated events and PICU outcomes. Pediatr Crit Care Med. 2017;18:310-318.; Li S, Rehder KJ, Giuliano JS Jr, et al. Development of a quality improvement bundle to reduce tracheal intubation-associated events in pediatric ICUs. Am J Med Qual. 2016;31:47-55.; Aggarwal R, Mytton OT, Derbrew M, et al. Training and simulation for patient safety. Qual Saf Health Care. 2010;19:i34-i43.; Lingappan K, Arnold JL, Fernandes CJ, Pammi M. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates. Cochrane Database Syst Rev. 2018;6:CD009975-CD.; Abdelgadir IS, Phillips RS, Singh D, Moncreiff MP, Lumsden JL. Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in children (Excluding neonates). Cochrane Database Syst Rev. 2017;5:CD011413.; Bailey CR. Time to stop using uncuffed tracheal tubes in children? Anaesthesia. 2018;73:147-150.; Chen L, Zhang J, Pan G, Li X, Shi T, He W. Cuffed versus uncuffed endotracheal tubes in pediatrics: a meta-analysis. Open Med (Wars). 2018;13:366-373.; Boerboom SL, Muthukrishnan SM, de Graaff JC, Jonker G. Cuffed or uncuffed endotracheal tubes in pediatric anesthesia: a survey of current practice in the United Kingdom and the Netherlands. Paediatr Anaesth. 2015;25:431-432.; Sathyamoorthy M, Lerman J, Okhomina VI, Penman AD. Use of cuffed tracheal tubes in neonates, infants and children: a practice survey of members of the society of pediatric anesthesia. J Clin Anesth. 2016;33:266-272.; Kolettas A, Grosomanidis V, Kolettas V, et al. Influence of apneic oxygenation in respiratory and circulatory system under general anesthesia. J Thorac Dis. 2014;6:S116-S145. |
| Contributed Indexing: | Keywords: airway management; emergency; intubation; pediatric |
| Entry Date(s): | Date Created: 20210328 Date Completed: 20210804 Latest Revision: 20210804 |
| Update Code: | 20260130 |
| DOI: | 10.1111/pan.14185 |
| PMID: | 33774880 |
| Database: | MEDLINE |
Journal Article