Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.
Duke-NUS Graduate School of Medicine, Singapore.
Pediatr Crit Care Med. 2019 Jan;20(1):1-8. doi: 10.1097/PCC.0000000000001782.
It is unknown if variation in tracheal intubation practice and outcomes exist across PICUs in different geographical regions. We hypothesized there would be differences in the process of care and adverse outcomes for tracheal intubation across PICUs in six different geographical regions (New Zealand, Japan, Singapore, Germany, India, and North America).
Prospective multicenter pediatric tracheal intubation database (National Emergency Airway Registry for Children) SETTING:: Six non-North American (International) and 36 North American PICUs.
All PICU tracheal intubation encounters from July 2014 to June 2017 MEASUREMENTS AND MAIN RESULTS:: Adverse tracheal intubation-associated events and desaturation occurrence (oxygen saturation < 80%) were evaluated. A total of 1,134 and 9,376 TIs from International and North American PICUs were reported, respectively: primary tracheal intubation 9,060, endotracheal tube change 1,450. The proportion of tracheal intubations for endotracheal tube change was greater in International PICUs (37% vs 11%; p < 0.001). Median age for International tracheal intubations was younger compared with North America (0 yr [interquartile range, 0-2 yr] vs 1 yr (0-7 yr); p < 0.001). Among primary tracheal intubations, the most common indication was respiratory (International 67%, North American 63%; p = 0.049). Direct laryngoscopy was the most common device in both International (86%) and North American (74%) tracheal intubations. Occurrence of any adverse tracheal intubation-associated event was New Zealand 8%, Japan 17%, Singapore 9%, Germany 17%, and India 6%; International 11% versus North American 14%; p value equals to 0.003. Desaturation was reported less commonly in International PICUs: 13% versus North American 17%; p equals to 0.001. International PICUs used cuffed endotracheal tube less often (52% vs 95%; p < 0.001). Proportion of cuffed endotracheal tube use per PICU was inversely correlated with the rate of tube change (r = -0.67; p < 0.001).
There were both similarities and differences in tracheal intubation practice and outcomes across international PICUs. Fewer adverse tracheal intubation-associated events were reported from International versus North American PICUs. International PICUs used cuffed endotracheal tube less often and had higher proportion of endotracheal tube change.
目前尚不清楚不同地理区域的儿科重症监护病房（PICU）在气管插管实践和结果方面是否存在差异。我们假设在六个不同地理区域（新西兰、日本、新加坡、德国、印度和北美）的 PICU 中，在气管插管的护理过程和不良结局方面会存在差异。
前瞻性多中心儿科气管插管数据库（国家儿童急症气道登记处）
6 个非北美（国际）和 36 个北美的 PICU。
2014 年 7 月至 2017 年 6 月期间所有 PICU 气管插管事件。
评估了与气管插管相关的不良事件和低氧血症（氧饱和度<80%）的发生情况。分别报告了来自国际和北美的 1134 例和 9376 例 TIs：主要气管插管 9060 例，气管内导管更换 1450 例。国际 PICU 中气管内导管更换的比例高于北美（37%比 11%；p<0.001）。国际气管插管的中位年龄比北美小（0 岁[四分位数范围，0-2 岁]比 1 岁[0-7 岁]；p<0.001）。在主要气管插管中，最常见的指征是呼吸系统（国际 67%，北美 63%；p=0.049）。直接喉镜在国际（86%）和北美（74%）气管插管中都是最常用的设备。任何与气管插管相关的不良事件的发生率在新西兰为 8%，日本为 17%，新加坡为 9%，德国为 17%，印度为 6%；国际为 11%，北美为 14%；p 值等于 0.003。国际 PICU 报告的低氧血症较少：13%比北美 17%；p=0.001。国际 PICU 较少使用带套囊的气管内导管（52%比 95%；p<0.001）。每个 PICU 带套囊气管内导管的使用率与气管内导管更换率呈负相关（r=-0.67；p<0.001）。
国际 PICU 之间的气管插管实践和结果既有相似之处，也有不同之处。与北美 PICU 相比，国际 PICU 报告的与气管插管相关的不良事件较少。国际 PICU 较少使用带套囊的气管内导管，气管内导管更换的比例较高。
