Gradidge Eleanor A, Bakar Adnan, Tellez David, Ruppe Michael, Tallent Sarah, Bird Geoffrey, Lavin Natasha, Lee Anthony, Nadkarni Vinay, Adu-Darko Michelle, Bain Jesse, Biagas Katherine, Branca Aline, Breuer Ryan K, Brown Calvin, Bysani Kris, Emeriaud Guillaume, Gangadharan Sandeep, Giuliano John S, Howell Joy D, Krawiec Conrad, Lee Jan Hau, Li Simon, Meyer Keith, Miksa Michael, Napolitano Natalie, Nett Sholeen, Nuthall Gabrielle, Orioles Alberto, Owen Erin B, Parker Margaret M, Parsons Simon, Polikoff Lee A, Rehder Kyle, Saito Osamu, Sanders Ron C, Shenoi Asha, Simon Dennis W, Skippen Peter W, Tarquinio Keiko, Thompson Anne, Toedt-Pingel Iris, Walson Karen, Nishisaki Akira
1Division of Pediatric Critical Care,Phoenix Children's Hospital,Phoenix,AZ,USA.
2Pediatric Cardiology,Cohen Children's Medical Center,Northwell Health System,Hofstra School of Medicine,New Hyde Park,NY,USA.
Cardiol Young. 2018 Jul;28(7):928-937. doi: 10.1017/S1047951118000495. Epub 2018 Apr 25.
IntroductionChildren with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.Materials and methodsWe sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
引言
患有先天性心脏病（CHD）和后天性心脏病的儿童具有独特的高风险生理状况。与非心脏病患儿相比，他们发生气管插管相关不良事件的风险可能更高。
材料与方法
我们试图评估心脏病患儿与非心脏病患儿气管插管相关不良事件的发生情况。使用国家儿童紧急气道注册系统（NEAR4KIDS）质量改进注册库，对来自38个国际儿科重症监护病房的气管插管进行了回顾性分析。主要结局是任何气管插管相关事件的发生情况。次要结局包括严重气管插管相关事件的发生情况、多次插管尝试以及氧饱和度下降。
结果
2012年7月至2016年3月期间共报告了8851次插管。心脏病患者年龄更小，更易出现血流动力学不稳定，且以呼吸衰竭为插管指征的可能性更小。气管插管相关事件的总体发生率无差异（心脏病患者：17% 对非心脏病患者：16%，p = 0.13），严重气管插管相关事件的发生率也无差异（心脏病患者：7% 对非心脏病患者：6%，p = 0.11）。即使在对患者和医护人员差异进行校正后，气管插管相关心脏骤停在心脏病患者中更常发生（2.80对1.28%；p < 0.001）（校正优势比1.79；p = 0.03）。心脏病患者多次插管尝试较少（p = 0.04），即使排除患有青紫型心脏病的患者，氧饱和度下降也更常发生。
结论
心脏病患者气管插管相关不良事件的总体发生率与非心脏病患者无异。然而，心脏病诊断与气管插管相关心脏骤停和氧饱和度下降的较高发生率相关。
