1Department of Pediatrics, Division of Pediatric Critical Care Medicine, Duke Children's Hospital, Durham, NC. 2Department of Pediatrics, Division of Critical Care Medicine, Yale University School of Medicine, New Haven, CT. 3Department of Nursing, Respiratory Care, and Neurodiagnostics, The Children's Hospital of Philadelphia, Philadelphia, PA. 4Division of Pediatric Intensive Care, Starship Children's Health Center, Grafton, Auckland, New Zealand. 5Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA.
Crit Care Med. 2015 Dec;43(12):2668-74. doi: 10.1097/CCM.0000000000001313.
Adverse tracheal intubation-associated events are common in PICUs. Prior studies suggest provider and practice factors are important contributors to tracheal intubation-associated events. Little is known about how the incidence of tracheal intubation-associated events is affected by the time of day, day of the week, or presence of in-hospital attending-level intensivists. We hypothesize that tracheal intubations occurring during nights and weekends are associated with a higher frequency of tracheal intubation-associated events.
Retrospective observational cohort study.
Twenty international PICUs.
Critically ill children requiring tracheal intubation.
None.
We analyzed 5,096 tracheal intubation courses from July 2010 to March 2014 from the prospective multicenter National Emergency Airway Registry for Children. Frequency of a priori-defined tracheal intubation-associated events was the primary outcome. Occurrence of any tracheal intubation-associated events and severe tracheal intubation-associated events were more common during nights (19:00 to 06:59) and weekends compared with weekdays (19% vs 16%, p = 0.01; 7% vs 6%, p = 0.05, respectively). This difference was significant in emergent intubations after adjusting for site-level clustering and patient factors: for any tracheal intubation-associated events: adjusted odds ratio, 1.20; 95% CI, 1.02-1.41; p = 0.03; but not significant in nonemergent intubations: adjusted odds ratio, 0.94; 95% CI, 0.63-1.40; p = 0.75. For emergent intubations, PICUs with home-call attending coverage had a significantly higher frequency of tracheal intubation-associated events during nights and weekends (adjusted odds ratio, 1.29; 95% CI, 1.01-1.66; p = 0.04), and this difference was attenuated in PICUs with in-hospital attending coverage (adjusted odds ratio, 1.12; 95% CI, 0.91-1.39; p = 0.28).
Higher occurrence of tracheal intubation-associated events was observed during nights and weekends. This difference was primarily attributed to emergent intubations. In- hospital attending physician coverage attenuated this discrepancy between weekdays versus nights and weekends but was not fully protective for tracheal intubation-associated events.
儿科重症监护病房（PICU）中，与气管插管相关的不良事件较为常见。既往研究表明，医护人员及操作相关因素是与气管插管相关不良事件相关的重要因素。目前尚不清楚一天中的时间、一周中的天数或院内主治医生的存在如何影响与气管插管相关不良事件的发生率。我们假设夜间和周末进行的气管插管与更高频率的与气管插管相关不良事件相关。
回顾性观察性队列研究。
20 家国际儿科重症监护病房。
需要气管插管的危重症儿童。
无。
我们分析了 2010 年 7 月至 2014 年 3 月期间来自前瞻性多中心国家儿童急诊气道登记处的 5096 例气管插管。主要结局是预先定义的与气管插管相关不良事件的发生频率。与工作日相比，夜间（19:00 至 06:59）和周末发生任何与气管插管相关不良事件和严重与气管插管相关不良事件更为常见（19% vs. 16%，p=0.01；7% vs. 6%，p=0.05）。在调整了站点水平聚类和患者因素后，这种差异在紧急插管中具有统计学意义：对于任何与气管插管相关不良事件：调整后的优势比为 1.20；95%置信区间为 1.02-1.41；p=0.03；但在非紧急插管中无统计学意义：调整后的优势比为 0.94；95%置信区间为 0.63-1.40；p=0.75。对于紧急插管，有主治医生随叫随到的儿科重症监护病房夜间和周末发生与气管插管相关不良事件的频率明显更高（调整后的优势比为 1.29；95%置信区间为 1.01-1.66；p=0.04），而在有院内主治医生覆盖的儿科重症监护病房中，这种差异减弱（调整后的优势比为 1.12；95%置信区间为 0.91-1.39；p=0.28）。
夜间和周末发生与气管插管相关不良事件的频率更高。这种差异主要归因于紧急插管。院内主治医生的覆盖减轻了工作日与夜间和周末之间的这种差异，但并不能完全预防与气管插管相关不良事件。
