Capone Christine A, Emerson Beth, Sweberg Todd, Polikoff Lee, Turner David A, Adu-Darko Michelle, Li Simon, Glater-Welt Lily B, Howell Joy, Brown Calvin A, Donoghue Aaron, Krawiec Conrad, Shults Justine, Breuer Ryan, Swain Kelly, Shenoi Asha, Krishna Ashwin S, Al-Subu Awni, Harwayne-Gidansky Ilana, Biagas Katherine V, Kelly Serena P, Nuthall Gabrielle, Panisello Josep, Napolitano Natalie, Giuliano John S, Emeriaud Guillaume, Toedt-Pingel Iris, Lee Anthony, Page-Goertz Christopher, Kimura Dai, Kasagi Mioko, D'Mello Jenn, Parsons Simon J, Mallory Palen, Gima Masafumi, Bysani G Kris, Motomura Makoto, Tarquinio Keiko M, Nett Sholeen, Ikeyama Takanari, Shetty Rakshay, Sanders Ronald C, Lee Jan Hau, Pinto Matthew, Orioles Alberto, Jung Philipp, Shlomovich Mark, Nadkarni Vinay, Nishisaki Akira
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York, USA.
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
Acad Emerg Med. 2022 Apr;29(4):406-414. doi: 10.1111/acem.14431. Epub 2022 Jan 12.
Tracheal intubation (TI) practice across pediatric emergency departments (EDs) has not been comprehensively reported. We aim to describe TI practice and outcomes in pediatric EDs in contrast to those in intensive are units (ICUs) and use the data to identify quality improvement targets.
Consecutive TI encounters from pediatric EDs and ICUs in the National Emergency Airway Registry for Children (NEAR4KIDS) database from 2015 to 2018 were analyzed for patient, provider, and practice characteristics and outcomes: adverse TI-associated events (TIAEs), oxygen desaturation (SpO < 80%), and procedural success. A multivariable model identified factors associated with TIAEs in the ED.
A total of 756 TIs in 13 pediatric EDs and 12,512 TIs in 51 pediatric/cardiac ICUs were reported. Median (interquartile range [IQR]) patient age for ED TIs was higher (32 [7-108] months) than that for ICU TIs (15 [3-91] months; p < 0.001). Proportion of TIs for respiratory decompensation (52% of ED vs. 64% ICU), shock (26% vs. 14%), and neurologic deterioration (30% vs. 11%) also differed by location. Limited neck mobility was reported more often in the ED (16% vs. 6%). TIs in the ED were performed more often via video laryngoscopy (64% vs. 29%). Adverse TIAE rates (15.6% ED, 14% ICU; absolute difference = 1.6%, 95% confidence interval [CI] = -1.1 to 4.2; p = 0.23) and severe TIAE rates (5.4% ED, 5.8% ICU; absolute difference = -0.3%, 95% CI = -2.0 to 1.3; p = 0.68) were not different. Oxygen desaturation was less commonly reported in ED TIs (13.6%) than ICU TIs (17%, absolute difference = -3.4%, 95% CI = -5.9 to -0.8; p = 0.016). Among ED TIs, shock as an indication (adjusted odds ratio [aOR] = 2.15, 95% CI = 1.26 to 3.65) and limited mouth opening (aOR = 1.74, 95% CI = 1.04 to 2.93) were independently associated with TIAEs.
While TI characteristics vary between pediatric EDs and ICUs, outcomes are similar. Shock and limited mouth opening were independently associated with adverse TI events in the ED.
儿科急诊科（ED）气管插管（TI）的实际情况尚未得到全面报道。我们旨在描述儿科ED中TI的实际情况和结果，并与重症监护病房（ICU）进行对比，利用这些数据确定质量改进目标。
分析2015年至2018年国家儿童急诊气道注册数据库（NEAR4KIDS）中儿科ED和ICU连续的TI病例，了解患者、医护人员、实际操作特点及结果：与TI相关的不良事件（TIAE）、氧饱和度下降（SpO₂<80%）和操作成功率。采用多变量模型确定ED中与TIAE相关的因素。
共报告了13家儿科ED中的756例TI和51家儿科/心脏ICU中的12512例TI。ED中TI患者的年龄中位数（四分位间距[IQR]）较高（32[7-108]个月），高于ICU中TI患者（15[3-91]个月；p<0.001）。因呼吸代偿失调进行TI的比例（ED为52%，ICU为64%）、休克（26%对14%）和神经功能恶化（30%对11%）在不同地点也有所不同。ED中报告颈部活动受限的情况更常见（16%对6%）。ED中TI更多通过视频喉镜进行（64%对29%）。不良TIAE发生率（ED为15.6%，ICU为14%；绝对差异=1.6%，95%置信区间[CI]=-1.1至4.2；p=0.23）和严重TIAE发生率（ED为5.4%，ICU为5.8%；绝对差异=-0.3%，95%CI=-2.0至1.3；p=0.68）没有差异。ED中TI时氧饱和度下降的报告较ICU中少见（13.6%对17%，绝对差异=-3.4%，95%CI=-5.9至-0.8；p=0.016）。在ED的TI中，作为指征的休克（调整优势比[aOR]=2.15，95%CI=1.26至3.65）和张口受限（aOR=1.74，95%CI=1.04至2.93）与TIAE独立相关。
虽然儿科ED和ICU中TI的特点不同，但结果相似。休克和张口受限与ED中TI不良事件独立相关。
