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Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children
BACKGROUND: Determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI), reduces adverse TI-associated events (TIAEs) in children. METHODS: AO was implemented across 14 pediatric intensive care units as a quality improvement intervention durin...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9847056/ https://www.ncbi.nlm.nih.gov/pubmed/36650568 http://dx.doi.org/10.1186/s13054-023-04304-0 |
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author | Napolitano, Natalie Polikoff, Lee Edwards, Lauren Tarquinio, Keiko M. Nett, Sholeen Krawiec, Conrad Kirby, Aileen Salfity, Nina Tellez, David Krahn, Gordon Breuer, Ryan Parsons, Simon J. Page-Goertz, Christopher Shults, Justine Nadkarni, Vinay Nishisaki, Akira |
author_facet | Napolitano, Natalie Polikoff, Lee Edwards, Lauren Tarquinio, Keiko M. Nett, Sholeen Krawiec, Conrad Kirby, Aileen Salfity, Nina Tellez, David Krahn, Gordon Breuer, Ryan Parsons, Simon J. Page-Goertz, Christopher Shults, Justine Nadkarni, Vinay Nishisaki, Akira |
author_sort | Napolitano, Natalie |
collection | PubMed |
description | BACKGROUND: Determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI), reduces adverse TI-associated events (TIAEs) in children. METHODS: AO was implemented across 14 pediatric intensive care units as a quality improvement intervention during 2016–2020. Implementation consisted of an intubation safety checklist, leadership endorsement, local champion, and data feedback to frontline clinicians. Standardized oxygen flow via nasal cannula for AO was as follows: 5 L/min for infants (< 1 year), 10 L/min for young children (1–7 years), and 15 L/min for older children (≥ 8 years). Outcomes were the occurrence of adverse TIAEs (primary) and hypoxemia (SpO(2) < 80%, secondary). RESULTS: Of 6549 TIs during the study period, 2554 (39.0%) occurred during the pre-implementation phase and 3995 (61.0%) during post-implementation phase. AO utilization increased from 23 to 68%, p < 0.001. AO was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patient intubated due to respiratory or neurological failure or shock. Conversely, AO was used more often in TIs done for procedures and those assisted by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%, p < 0.001), aOR 0.75 (95% CI 0.58–0.98, p = 0.03) after adjusting for site clustering (primary analysis). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs: aOR 0.90, 95% CI 0.72–1.12, p = 0.33 and the occurrence of hypoxemia was not different: AO 14.2% versus without AO 15.2%, p = 0.43. CONCLUSION: While AO use was associated with a lower occurrence of adverse TIAEs in children who required TI in the pediatric ICU after accounting for site-level clustering, this result may be explained by differences in patient, provider, and practice factors. Trial Registration Trial not registered. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-023-04304-0. |
format | Online Article Text |
id | pubmed-9847056 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-98470562023-01-19 Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children Napolitano, Natalie Polikoff, Lee Edwards, Lauren Tarquinio, Keiko M. Nett, Sholeen Krawiec, Conrad Kirby, Aileen Salfity, Nina Tellez, David Krahn, Gordon Breuer, Ryan Parsons, Simon J. Page-Goertz, Christopher Shults, Justine Nadkarni, Vinay Nishisaki, Akira Crit Care Research BACKGROUND: Determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI), reduces adverse TI-associated events (TIAEs) in children. METHODS: AO was implemented across 14 pediatric intensive care units as a quality improvement intervention during 2016–2020. Implementation consisted of an intubation safety checklist, leadership endorsement, local champion, and data feedback to frontline clinicians. Standardized oxygen flow via nasal cannula for AO was as follows: 5 L/min for infants (< 1 year), 10 L/min for young children (1–7 years), and 15 L/min for older children (≥ 8 years). Outcomes were the occurrence of adverse TIAEs (primary) and hypoxemia (SpO(2) < 80%, secondary). RESULTS: Of 6549 TIs during the study period, 2554 (39.0%) occurred during the pre-implementation phase and 3995 (61.0%) during post-implementation phase. AO utilization increased from 23 to 68%, p < 0.001. AO was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patient intubated due to respiratory or neurological failure or shock. Conversely, AO was used more often in TIs done for procedures and those assisted by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs. without AO 13.5%, p < 0.001), aOR 0.75 (95% CI 0.58–0.98, p = 0.03) after adjusting for site clustering (primary analysis). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs: aOR 0.90, 95% CI 0.72–1.12, p = 0.33 and the occurrence of hypoxemia was not different: AO 14.2% versus without AO 15.2%, p = 0.43. CONCLUSION: While AO use was associated with a lower occurrence of adverse TIAEs in children who required TI in the pediatric ICU after accounting for site-level clustering, this result may be explained by differences in patient, provider, and practice factors. Trial Registration Trial not registered. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-023-04304-0. BioMed Central 2023-01-17 /pmc/articles/PMC9847056/ /pubmed/36650568 http://dx.doi.org/10.1186/s13054-023-04304-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Napolitano, Natalie Polikoff, Lee Edwards, Lauren Tarquinio, Keiko M. Nett, Sholeen Krawiec, Conrad Kirby, Aileen Salfity, Nina Tellez, David Krahn, Gordon Breuer, Ryan Parsons, Simon J. Page-Goertz, Christopher Shults, Justine Nadkarni, Vinay Nishisaki, Akira Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children |
title | Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children |
title_full | Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children |
title_fullStr | Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children |
title_full_unstemmed | Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children |
title_short | Effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children |
title_sort | effect of apneic oxygenation with intubation to reduce severe desaturation and adverse tracheal intubation-associated events in critically ill children |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9847056/ https://www.ncbi.nlm.nih.gov/pubmed/36650568 http://dx.doi.org/10.1186/s13054-023-04304-0 |
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