Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, PA, USA.
Crit Care Med. 2013 Mar;41(3):874-85. doi: 10.1097/CCM.0b013e3182746736.
To characterize the landscape of process of care and safety outcomes for tracheal intubation across pediatric intensive care units
Procedural process of care and safety outcomes of tracheal intubation across pediatric intensive care units has not been described. We hypothesize that the novel National Emergency Airway Registry for Children registry is a feasible tool to capture tracheal intubation process of care and outcomes.
Prospective, descriptive.
Fifteen academic PICUs in North America.
Critically ill children requiring tracheal intubation in PICUs.
Tracheal intubation quality improvement data were prospectively collected for all initial tracheal intubation in 15 PICUs from July 2010 to December 2011 using the National Emergency Airway Registry for Children tool with explicit site-specific compliance plans and operational definitions including adverse tracheal intubation associated events.
One thousand seven hundred fifteen tracheal intubation encounters were reported (averaging 1/3.4 days, or 1/86 bed days). Ninety-eight percent of primary tracheal intubation were successful; 86% were successful with less than or equal to two attempts. First attempt was by pediatric residents in 23%, pediatric critical care fellows in 41%, and critical care attending physicians in 13%: first attempt success rate was 62%, first provider success rate was 79%. The first method was oral intubation in 1,659 (98%) and nasal in 55 (2%). Direct laryngoscopy was used in 96%. Ninety percent of tracheal intubation were with cuffed tracheal tubes. Adverse tracheal intubation associated events were reported in 20% of intubations (n = 372), with severe tracheal intubation associated events in 6% (n = 115). Esophageal intubation with immediate recognition was the most common tracheal intubation associated events (n = 167, 9%). History of difficult airway, diagnostic category, unstable hemodynamics, and resident provider as first airway provider were associated with occurrence of tracheal intubation associated events. Severe tracheal intubation associated events were associated with diagnostic category and pre-existing unstable hemodynamics. Elective tracheal intubation status was associated with fewer severe tracheal intubation associated events.
National Emergency Airway Registry for Children was feasible to characterize PICU tracheal intubation procedural process of care and safety outcomes. Self-reported adverse tracheal intubation associated events occurred frequently and were associated with patient, provider, and practice characteristics.
描述儿科重症监护病房（PICU）中气管插管的护理流程和安全结果。
尚未对 PICU 中气管插管的护理流程和安全结果进行描述。我们假设新的国家儿童急诊气道登记处（National Emergency Airway Registry for Children，NEAR4Kids）是一种可行的工具，可以获取气管插管的护理流程和结果。
前瞻性描述性研究。
北美 15 家学术性儿科重症监护病房。
需要在 PICU 中进行气管插管的危重症儿童。
2010 年 7 月至 2011 年 12 月期间，使用国家儿童急诊气道登记处工具，通过专门的网站特定合规计划和操作定义，对 15 家儿科重症监护病房中的所有初次气管插管进行了前瞻性质量改进数据收集，其中包括不良气管插管相关事件。
共报告了 1715 次气管插管（平均每 3.4 天/86 个床位日 1 次）。98%的原发性气管插管成功；86%在尝试 1 至 2 次后成功。首次尝试是由儿科住院医师完成的，占 23%，儿科重症监护医师完成的占 41%，重症监护医生完成的占 13%：首次尝试成功率为 62%，首次提供者成功率为 79%。首次方法是口腔插管 1659 例（98%），鼻插管 55 例（2%）。直接喉镜使用率为 96%。90%的气管插管使用带套囊的气管导管。20%（n=372）的气管插管报告了不良气管插管相关事件，其中 6%（n=115）为严重气管插管相关事件。食管插管并立即识别是最常见的气管插管相关事件（n=167，9%）。困难气道史、诊断类别、不稳定的血流动力学和住院医师作为第一气道提供者与气管插管相关事件的发生相关。严重气管插管相关事件与诊断类别和预先存在的血流动力学不稳定相关。择期气管插管状态与较少的严重气管插管相关事件相关。
国家儿童急诊气道登记处（NEAR4Kids）可用于描述 PICU 气管插管的护理流程和安全性结果。自我报告的不良气管插管相关事件频繁发生，与患者、提供者和实践特征相关。
