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The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study

BACKGROUND: The impact of multiple tracheal intubation (TI) attempts on outcomes in critically ill children with acute respiratory failure is not known. The objective of our study is to determine the association between number of TI attempts and severe desaturation (S(p)O(2) < 70 %) and adverse T...

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Autores principales: Lee, Jan Hau, Turner, David A., Kamat, Pradip, Nett, Sholeen, Shults, Justine, Nadkarni, Vinay M., Nishisaki, Akira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851769/
https://www.ncbi.nlm.nih.gov/pubmed/27130327
http://dx.doi.org/10.1186/s12887-016-0593-y
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author Lee, Jan Hau
Turner, David A.
Kamat, Pradip
Nett, Sholeen
Shults, Justine
Nadkarni, Vinay M.
Nishisaki, Akira
author_facet Lee, Jan Hau
Turner, David A.
Kamat, Pradip
Nett, Sholeen
Shults, Justine
Nadkarni, Vinay M.
Nishisaki, Akira
author_sort Lee, Jan Hau
collection PubMed
description BACKGROUND: The impact of multiple tracheal intubation (TI) attempts on outcomes in critically ill children with acute respiratory failure is not known. The objective of our study is to determine the association between number of TI attempts and severe desaturation (S(p)O(2) < 70 %) and adverse TI associated events (TIAEs). METHODS: We performed an analysis of a prospective multicenter TI database (National Emergency Airway Registry for Children: NEAR4KIDS). Primary exposure variable was number of TI attempts trichotomized as one, two, or ≥3 attempts. Estimates were adjusted for history of difficult airway, upper airway obstruction, and age. We included all children with initial TI performed with direct laryngoscopy for acute respiratory failure between 7/2010-3/2013. Our main outcome measures were desaturation (<80 % during TI attempt), severe desaturation (<70 %), adverse and severe TIAEs (e.g., cardiac arrest, hypotension requiring treatment). RESULTS: Of 3382 TIs, 2080(65 %) were for acute respiratory failure. First attempt success was achieved in 1256/2080(60 %), second attempt in 503/2080(24 %), and ≥3 attempts in 321/2080(15 %). Higher number of attempts was associated with younger age, history of difficult airway, signs of upper airway obstruction, and first provider training level. The proportion of TIs with desaturation increased with increasing number of attempts (1 attempt:16 %, 2 attempts:36 %, ≥3 attempts:56 %, p < 0.001; adjusted OR for 2 attempts: 2.9[95 % CI:2.3–3.7]; ≥3 attempts: 6.5[95 % CI: 5.0–8.5], adjusted for patient factors). Proportion of TIs with severe desaturation also increased with increasing number of attempts (1 attempt:12 %, 2 attempts:30 %, ≥3 attempts:44 %, p < 0.001); adjusted OR for 2 attempts: 3.1[95 % CI:2.4–4.0]; ≥3 attempts: 5.7[95 % CI: 4.3–7.5] ). TIAE rates increased from 10 to 29 to 38 % with increasing number of attempts (p < 0.001); adjusted OR for 2 attempts: 3.7[95 % CI:2.9–4.9] ; ≥3 attempts: 5.5[95 % CI: 4.1–7.4]. Severe TIAE rates went from 5 to 8 to 9 % (p = 0.008); adjusted OR for 2 attempts: 1.6 [95 % CI:1.1–2.4]; ≥3 attempts: 1.8[95 % CI:1.1–2.8]. CONCLUSIONS: Number of TI attempts was associated with desaturations and increased occurrence of TIAEs in critically ill children with acute respiratory failure. Thoughtful attention to initial provider as well as optimal setting/preparation is important to maximize the chance for first attempt success and to avoid desaturation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12887-016-0593-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-48517692016-05-01 The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study Lee, Jan Hau Turner, David A. Kamat, Pradip Nett, Sholeen Shults, Justine Nadkarni, Vinay M. Nishisaki, Akira BMC Pediatr Research Article BACKGROUND: The impact of multiple tracheal intubation (TI) attempts on outcomes in critically ill children with acute respiratory failure is not known. The objective of our study is to determine the association between number of TI attempts and severe desaturation (S(p)O(2) < 70 %) and adverse TI associated events (TIAEs). METHODS: We performed an analysis of a prospective multicenter TI database (National Emergency Airway Registry for Children: NEAR4KIDS). Primary exposure variable was number of TI attempts trichotomized as one, two, or ≥3 attempts. Estimates were adjusted for history of difficult airway, upper airway obstruction, and age. We included all children with initial TI performed with direct laryngoscopy for acute respiratory failure between 7/2010-3/2013. Our main outcome measures were desaturation (<80 % during TI attempt), severe desaturation (<70 %), adverse and severe TIAEs (e.g., cardiac arrest, hypotension requiring treatment). RESULTS: Of 3382 TIs, 2080(65 %) were for acute respiratory failure. First attempt success was achieved in 1256/2080(60 %), second attempt in 503/2080(24 %), and ≥3 attempts in 321/2080(15 %). Higher number of attempts was associated with younger age, history of difficult airway, signs of upper airway obstruction, and first provider training level. The proportion of TIs with desaturation increased with increasing number of attempts (1 attempt:16 %, 2 attempts:36 %, ≥3 attempts:56 %, p < 0.001; adjusted OR for 2 attempts: 2.9[95 % CI:2.3–3.7]; ≥3 attempts: 6.5[95 % CI: 5.0–8.5], adjusted for patient factors). Proportion of TIs with severe desaturation also increased with increasing number of attempts (1 attempt:12 %, 2 attempts:30 %, ≥3 attempts:44 %, p < 0.001); adjusted OR for 2 attempts: 3.1[95 % CI:2.4–4.0]; ≥3 attempts: 5.7[95 % CI: 4.3–7.5] ). TIAE rates increased from 10 to 29 to 38 % with increasing number of attempts (p < 0.001); adjusted OR for 2 attempts: 3.7[95 % CI:2.9–4.9] ; ≥3 attempts: 5.5[95 % CI: 4.1–7.4]. Severe TIAE rates went from 5 to 8 to 9 % (p = 0.008); adjusted OR for 2 attempts: 1.6 [95 % CI:1.1–2.4]; ≥3 attempts: 1.8[95 % CI:1.1–2.8]. CONCLUSIONS: Number of TI attempts was associated with desaturations and increased occurrence of TIAEs in critically ill children with acute respiratory failure. Thoughtful attention to initial provider as well as optimal setting/preparation is important to maximize the chance for first attempt success and to avoid desaturation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12887-016-0593-y) contains supplementary material, which is available to authorized users. BioMed Central 2016-04-29 /pmc/articles/PMC4851769/ /pubmed/27130327 http://dx.doi.org/10.1186/s12887-016-0593-y Text en © Lee et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Lee, Jan Hau
Turner, David A.
Kamat, Pradip
Nett, Sholeen
Shults, Justine
Nadkarni, Vinay M.
Nishisaki, Akira
The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study
title The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study
title_full The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study
title_fullStr The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study
title_full_unstemmed The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study
title_short The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study
title_sort number of tracheal intubation attempts matters! a prospective multi-institutional pediatric observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851769/
https://www.ncbi.nlm.nih.gov/pubmed/27130327
http://dx.doi.org/10.1186/s12887-016-0593-y
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