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Frequency of Desaturation and Association With Hemodynamic Adverse Events During Tracheal Intubations in PICUs.

Publication ,  Journal Article
Li, S; Hsieh, T-C; Rehder, KJ; Nett, S; Kamat, P; Napolitano, N; Turner, DA; Adu-Darko, M; Jarvis, JD; Krawiec, C; Derbyshire, AT; Meyer, K ...
Published in: Pediatr Crit Care Med
January 2018

OBJECTIVES: Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association with adverse hemodynamic tracheal intubation-associated events. DESIGN: Retrospective cohort study as a part of the National Emergency Airway Registry for Children Network's quality improvement project from January 2012 to December 2014. SETTING: International PICUs. PATIENTS: Critically ill children younger than 18 years undergoing primary tracheal intubations in the ICUs. INTERVENTIONS: tracheal intubation processes of care and outcomes were prospectively collected using standardized operational definitions. We defined moderate desaturation as oxygen saturation less than 80% and severe desaturation as oxygen saturation less than 70% during tracheal intubation procedures in children with initial oxygen saturation greater than 90% after preoxygenation. Adverse hemodynamic tracheal intubation-associated event was defined as cardiac arrests, hypo or hypertension requiring intervention, and dysrhythmia. MEASUREMENTS AND MAIN RESULTS: A total of 5,498 primary tracheal intubations from 31 ICUs were reported. Moderate desaturation was observed in 19.3% associated with adverse hemodynamic tracheal intubation-associated events (9.8% among children with moderate desaturation vs 4.4% without desaturation; p < 0.001). Severe desaturation was observed in 12.9% of tracheal intubations, also significantly associated with hemodynamic tracheal intubation-associated events. After adjusting for patient, provider, and practice factors, the occurrence of moderate desaturation was independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 1.83 (95% CI, 1.34-2.51; p < 0.001). The occurrence of severe desaturation was also independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 2.16 (95% CI, 1.54-3.04; p < 0.001). Number of tracheal intubation attempts was also significantly associated with the frequency of moderate and severe desaturations (p < 0.001). CONCLUSIONS: In this large tracheal intubation quality improvement database, we found moderate and severe desaturation are reported among 19% and 13% of all tracheal intubation encounters. Moderate and severe desaturations were independently associated with the occurrence of adverse hemodynamic events. Future quality improvement interventions may focus to reduce desaturation events.

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Published In

Pediatr Crit Care Med

DOI

ISSN

1529-7535

Publication Date

January 2018

Volume

19

Issue

1

Start / End Page

e41 / e50

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Registries
  • Quality Improvement
  • Pediatrics
  • Oxygen
  • Male
  • Intubation, Intratracheal
  • Intensive Care Units, Pediatric
  • Infant
  • Hypoxia
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Li, S., Hsieh, T.-C., Rehder, K. J., Nett, S., Kamat, P., Napolitano, N., … for National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, . (2018). Frequency of Desaturation and Association With Hemodynamic Adverse Events During Tracheal Intubations in PICUs. Pediatr Crit Care Med, 19(1), e41–e50. https://doi.org/10.1097/PCC.0000000000001384
Li, Simon, Ting-Chang Hsieh, Kyle J. Rehder, Sholeen Nett, Pradip Kamat, Natalie Napolitano, David A. Turner, et al. “Frequency of Desaturation and Association With Hemodynamic Adverse Events During Tracheal Intubations in PICUs.Pediatr Crit Care Med 19, no. 1 (January 2018): e41–50. https://doi.org/10.1097/PCC.0000000000001384.
Li S, Hsieh T-C, Rehder KJ, Nett S, Kamat P, Napolitano N, et al. Frequency of Desaturation and Association With Hemodynamic Adverse Events During Tracheal Intubations in PICUs. Pediatr Crit Care Med. 2018 Jan;19(1):e41–50.
Li, Simon, et al. “Frequency of Desaturation and Association With Hemodynamic Adverse Events During Tracheal Intubations in PICUs.Pediatr Crit Care Med, vol. 19, no. 1, Jan. 2018, pp. e41–50. Pubmed, doi:10.1097/PCC.0000000000001384.
Li S, Hsieh T-C, Rehder KJ, Nett S, Kamat P, Napolitano N, Turner DA, Adu-Darko M, Jarvis JD, Krawiec C, Derbyshire AT, Meyer K, Giuliano JS, Tala J, Tarquinio K, Ruppe MD, Sanders RC, Pinto M, Howell JD, Parker MM, Nuthall G, Shepherd M, Emeriaud G, Nagai Y, Saito O, Lee JH, Simon DW, Orioles A, Walson K, Vanderford P, Shenoi A, Lee A, Bird GL, Miksa M, Graciano AL, Bain J, Skippen PW, Polikoff LA, Nadkarni V, Nishisaki A, for National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Frequency of Desaturation and Association With Hemodynamic Adverse Events During Tracheal Intubations in PICUs. Pediatr Crit Care Med. 2018 Jan;19(1):e41–e50.

Published In

Pediatr Crit Care Med

DOI

ISSN

1529-7535

Publication Date

January 2018

Volume

19

Issue

1

Start / End Page

e41 / e50

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Registries
  • Quality Improvement
  • Pediatrics
  • Oxygen
  • Male
  • Intubation, Intratracheal
  • Intensive Care Units, Pediatric
  • Infant
  • Hypoxia