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Published on: January 17, 2011
Adverse Tracheal Intubation-Associated Events in Pediatric Patients at Nonspecialist Centers: A Multicenter
Adela Matettore1,2, Padmanabhan Ramnarayan1,3, Andrew Jones1,2
1Children's Acute Transport Service, Boswell Street, Great Ormond Street Hospital, London, United Kingdom.
Insights
Pediatric tracheal intubation events are common in local hospitals, with severe complications occurring more frequently than in specialized pediatric intensive care units (PICUs). Improving intubation safety in these non-PICU settings is crucial.
Area of Science:
- Pediatric critical care medicine
- Emergency medicine
- Anesthesiology
Background:
- Adverse tracheal intubation-associated events are frequent in pediatric intensive care units (PICUs).
- Pediatric patients often require intubation by local teams in nonspecialist centers, where event rates are less studied.
- This study investigated tracheal intubation-associated event rates in nonspecialist settings.
Purpose of the Study:
- To determine the rate of tracheal intubation-associated events in pediatric patients intubated in nonspecialist centers.
- To identify risk factors for these events.
- To compare event rates with those in tertiary PICUs.
Main Methods:
- A prospective observational study was conducted across 47 local hospitals in the UK.
- Data were collected for children transported by the Children's Acute Transport Service from June 2016 to May 2018.
- 1,051 patients' intubation data were analyzed.
Main Results:
- The overall rate of tracheal intubation-associated events was 22.7%, with severe events in 13.8%.
- Younger, small-for-age, and patients with difficult airways or comorbidities had higher complication rates.
- Independent predictors included multiple intubation attempts and the intubator's specialty (emergency medicine vs. anesthesiology).
Conclusions:
- Tracheal intubation-associated events are common in critically ill pediatric patients in nonspecialist centers.
- Severe event rates are significantly higher in these settings compared to PICUs.
- Enhanced focus on improving intubation safety in nonspecialist centers is warranted.
Objectives:
In tertiary care PICUs, adverse tracheal intubation-associated events occur frequently (20%; severe tracheal intubation-associated events in 3-6.5%). However, pediatric patients often present to nonspecialist centers and require intubation by local teams. The rate of tracheal intubation-associated events is not well studied in this setting. We hypothesized that the rate of tracheal intubation-associated events would be higher in nonspecialist centers.
Design:
Prospective observational study.
Setting:
We conducted a multicenter study covering 47 local hospitals in the North Thames and East Anglia region of the United Kingdom.
Patients:
All intubated children transported by the Children's Acute Transport Service from June 2016 to May 2018.
Interventions:
None.
Measurements And Main Results:
Data were available in 1,051 of 1,237 eligible patients (85%). The overall rate of tracheal intubation-associated events was 22.7%, with severe tracheal intubation-associated events occurring in 13.8%. Younger, small-for-age patients and those with difficult airways had a higher rate of complications. Children with comorbidities and difficult airways were found to have increased severe tracheal intubation-associated events. The most common tracheal intubation-associated events were endobronchial intubation (6.2%), hypotension (5.4%), and bradycardia (4.2%). In multivariate analysis, independent predictors of tracheal intubation-associated events were number of intubation attempts (odds ratio for > 4 attempts compared with a single attempt 19.1; 95% CI, 5.9-61.4) and the specialty of the intubator (emergency medicine compared with anesthesiologists odds ratio 6.9; 95% CI, 1.1-41.4).
Conclusions:
Tracheal intubation-associated events are common in critically ill pediatric patients who present to nonspecialist centers. The rate of severe tracheal intubation-associated events is much higher in these centers as compared with the PICU setting. There should be a greater focus on improving the safety of intubations occurring in nonspecialist centers.
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