Effect of Location on Tracheal Intubation Safety in Cardiac Disease—Are Cardiac ICUs Safer?

Eleanor A. Gradidge, Adnan Bakar, David Tellez, Michael Ruppe, Sarah Tallent, Geoffrey Bird, Natasha Lavin, Anthony Lee, Michelle Adu-Darko, Jesse Bain, Katherine Biagas, Aline Branca, Ryan K. Breuer, Calvin Brown Brown, G. Kris Bysani, Ira M. Cheifitz, Guillaume Emeriaud, Sandeep Gangadharan, John S. Giuliano Giuliano, Joy D. HowellConrad Krawiec, Jan Hau Lee, Simon Li, Keith Meyer, Michael Miksa, Natalie Napolitano, Sholeen Nett, Gabrielle Nuthall, Alberto Orioles, Erin B. Owen, Margaret M. Parker, Simon Parsons, Lee A. Polikoff, Kyle Rehder, Osamu Saito, Ronald C. Sanders Sanders, Asha N. Shenoi, Dennis W. Simon, Peter W. Skippen, Keiko Tarquinio, Anne Thompson, Iris Toedt-Pingel, Paula Vanderford, Karen Walson, Vinay Nadkarni, Akira Nishisaki

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Evaluate differences in tracheal intubation–associated events and process variances (i.e., multiple intubation attempts and oxygen desaturation) between pediatric cardiac ICUs and noncardiac PICUs in children with underlying cardiac disease. Design: Retrospective cohort study using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children). Setting: Thirty-six PICUs (five cardiac ICUs, 31 noncardiac ICUs) from July 2012 to March 2016. Patients: Children with medical or surgical cardiac disease who underwent intubation in an ICU. Interventions: None. Measurements and Main Results: Our primary outcome was the rate of any adverse tracheal intubation–associated event. Secondary outcomes were severe tracheal intubation–associated events, multiple tracheal intubation attempt rates, and oxygen desaturation. There were 1,502 tracheal intubations in children with underlying cardiac disease (751 in cardiac ICUs, 751 in noncardiac ICUs) reported. Cardiac ICUs and noncardiac ICUs had similar proportions of patients with surgical cardiac disease. Patients undergoing intubation in cardiac ICUs were younger (median age, 1 mo [interquartile range, 0–6 mo]) compared with noncardiac ICUs (median 3 mo [interquartile range, 1–11 mo]; p < 0.001). Tracheal intubation–associated event rates were not different between cardiac ICUs and noncardiac ICUs (16% vs 19%; adjusted odds ratio, 0.74; 95% CI, 0.54–1.02; p = 0.069). However, in a sensitivity analysis comparing cardiac ICUs with mixed ICUs (i.e., ICUs caring for children with either general pediatric or cardiac diseases), cardiac ICUs had decreased odds of adverse events (adjusted odds ratio, 0.71; 95% CI, 0.52–0.97; p = 0.033). Rates of severe tracheal intubation–associated events and multiple attempts were similar. Desaturations occurred more often during intubation in cardiac ICUs (adjusted odds ratio, 1.61; 95% CI, 1.04–1.15; p = 0.002). Conclusions: In children with underlying cardiac disease, rates of adverse tracheal intubation–associated events were not lower in cardiac ICUs as compared to noncardiac ICUs, even after adjusting for differences in patient characteristics and care models.

Original languageEnglish (US)
Pages (from-to)218-227
Number of pages10
JournalPediatric Critical Care Medicine
DOIs
StateAccepted/In press - Mar 1 2018

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Intubation
Heart Diseases
Safety
Odds Ratio
Pediatrics
Oxygen
Quality Improvement
Registries
Patient Care
Emergencies
Cohort Studies
Retrospective Studies
Databases

Keywords

  • cardiac arrest
  • critical illness
  • heart disease
  • intubation
  • pediatric critical care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Gradidge, E. A., Bakar, A., Tellez, D., Ruppe, M., Tallent, S., Bird, G., ... Nishisaki, A. (Accepted/In press). Effect of Location on Tracheal Intubation Safety in Cardiac Disease—Are Cardiac ICUs Safer? Pediatric Critical Care Medicine, 218-227. https://doi.org/10.1097/PCC.0000000000001422

Effect of Location on Tracheal Intubation Safety in Cardiac Disease—Are Cardiac ICUs Safer? / Gradidge, Eleanor A.; Bakar, Adnan; Tellez, David; Ruppe, Michael; Tallent, Sarah; Bird, Geoffrey; Lavin, Natasha; Lee, Anthony; Adu-Darko, Michelle; Bain, Jesse; Biagas, Katherine; Branca, Aline; Breuer, Ryan K.; Brown Brown, Calvin; Bysani, G. Kris; Cheifitz, Ira M.; Emeriaud, Guillaume; Gangadharan, Sandeep; Giuliano 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 Sanders, Ronald C.; Shenoi, Asha N.; Simon, Dennis W.; Skippen, Peter W.; Tarquinio, Keiko; Thompson, Anne; Toedt-Pingel, Iris; Vanderford, Paula; Walson, Karen; Nadkarni, Vinay; Nishisaki, Akira.

In: Pediatric Critical Care Medicine, 01.03.2018, p. 218-227.

Research output: Contribution to journalArticle

Gradidge, EA, Bakar, A, Tellez, D, Ruppe, M, Tallent, S, Bird, G, Lavin, N, Lee, A, Adu-Darko, M, Bain, J, Biagas, K, Branca, A, Breuer, RK, Brown Brown, C, Bysani, GK, Cheifitz, IM, Emeriaud, G, Gangadharan, S, Giuliano Giuliano, JS, Howell, JD, Krawiec, C, Lee, JH, Li, S, Meyer, K, Miksa, M, Napolitano, N, Nett, S, Nuthall, G, Orioles, A, Owen, EB, Parker, MM, Parsons, S, Polikoff, LA, Rehder, K, Saito, O, Sanders Sanders, RC, Shenoi, AN, Simon, DW, Skippen, PW, Tarquinio, K, Thompson, A, Toedt-Pingel, I, Vanderford, P, Walson, K, Nadkarni, V & Nishisaki, A 2018, 'Effect of Location on Tracheal Intubation Safety in Cardiac Disease—Are Cardiac ICUs Safer?', Pediatric Critical Care Medicine, pp. 218-227. https://doi.org/10.1097/PCC.0000000000001422
Gradidge, Eleanor A. ; Bakar, Adnan ; Tellez, David ; Ruppe, Michael ; Tallent, Sarah ; Bird, Geoffrey ; Lavin, Natasha ; Lee, Anthony ; Adu-Darko, Michelle ; Bain, Jesse ; Biagas, Katherine ; Branca, Aline ; Breuer, Ryan K. ; Brown Brown, Calvin ; Bysani, G. Kris ; Cheifitz, Ira M. ; Emeriaud, Guillaume ; Gangadharan, Sandeep ; Giuliano 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 Sanders, Ronald C. ; Shenoi, Asha N. ; Simon, Dennis W. ; Skippen, Peter W. ; Tarquinio, Keiko ; Thompson, Anne ; Toedt-Pingel, Iris ; Vanderford, Paula ; Walson, Karen ; Nadkarni, Vinay ; Nishisaki, Akira. / Effect of Location on Tracheal Intubation Safety in Cardiac Disease—Are Cardiac ICUs Safer?. In: Pediatric Critical Care Medicine. 2018 ; pp. 218-227.
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abstract = "Objectives: Evaluate differences in tracheal intubation–associated events and process variances (i.e., multiple intubation attempts and oxygen desaturation) between pediatric cardiac ICUs and noncardiac PICUs in children with underlying cardiac disease. Design: Retrospective cohort study using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children). Setting: Thirty-six PICUs (five cardiac ICUs, 31 noncardiac ICUs) from July 2012 to March 2016. Patients: Children with medical or surgical cardiac disease who underwent intubation in an ICU. Interventions: None. Measurements and Main Results: Our primary outcome was the rate of any adverse tracheal intubation–associated event. Secondary outcomes were severe tracheal intubation–associated events, multiple tracheal intubation attempt rates, and oxygen desaturation. There were 1,502 tracheal intubations in children with underlying cardiac disease (751 in cardiac ICUs, 751 in noncardiac ICUs) reported. Cardiac ICUs and noncardiac ICUs had similar proportions of patients with surgical cardiac disease. Patients undergoing intubation in cardiac ICUs were younger (median age, 1 mo [interquartile range, 0–6 mo]) compared with noncardiac ICUs (median 3 mo [interquartile range, 1–11 mo]; p < 0.001). Tracheal intubation–associated event rates were not different between cardiac ICUs and noncardiac ICUs (16{\%} vs 19{\%}; adjusted odds ratio, 0.74; 95{\%} CI, 0.54–1.02; p = 0.069). However, in a sensitivity analysis comparing cardiac ICUs with mixed ICUs (i.e., ICUs caring for children with either general pediatric or cardiac diseases), cardiac ICUs had decreased odds of adverse events (adjusted odds ratio, 0.71; 95{\%} CI, 0.52–0.97; p = 0.033). Rates of severe tracheal intubation–associated events and multiple attempts were similar. Desaturations occurred more often during intubation in cardiac ICUs (adjusted odds ratio, 1.61; 95{\%} CI, 1.04–1.15; p = 0.002). Conclusions: In children with underlying cardiac disease, rates of adverse tracheal intubation–associated events were not lower in cardiac ICUs as compared to noncardiac ICUs, even after adjusting for differences in patient characteristics and care models.",
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author = "Gradidge, {Eleanor A.} and Adnan Bakar and David Tellez and Michael Ruppe and Sarah Tallent and Geoffrey Bird and Natasha Lavin and Anthony Lee and Michelle Adu-Darko and Jesse Bain and Katherine Biagas and Aline Branca and Breuer, {Ryan K.} and {Brown Brown}, Calvin and Bysani, {G. Kris} and Cheifitz, {Ira M.} and Guillaume Emeriaud and Sandeep Gangadharan and {Giuliano Giuliano}, {John S.} and Howell, {Joy D.} and Conrad Krawiec and Lee, {Jan Hau} and Simon Li and Keith Meyer and Michael Miksa and Natalie Napolitano and Sholeen Nett and Gabrielle Nuthall and Alberto Orioles and Owen, {Erin B.} and Parker, {Margaret M.} and Simon Parsons and Polikoff, {Lee A.} and Kyle Rehder and Osamu Saito and {Sanders Sanders}, {Ronald C.} and Shenoi, {Asha N.} and Simon, {Dennis W.} and Skippen, {Peter W.} and Keiko Tarquinio and Anne Thompson and Iris Toedt-Pingel and Paula Vanderford and Karen Walson and Vinay Nadkarni and Akira Nishisaki",
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TY - JOUR

T1 - Effect of Location on Tracheal Intubation Safety in Cardiac Disease—Are Cardiac ICUs Safer?

AU - Gradidge, Eleanor A.

AU - Bakar, Adnan

AU - Tellez, David

AU - Ruppe, Michael

AU - Tallent, Sarah

AU - Bird, Geoffrey

AU - Lavin, Natasha

AU - Lee, Anthony

AU - Adu-Darko, Michelle

AU - Bain, Jesse

AU - Biagas, Katherine

AU - Branca, Aline

AU - Breuer, Ryan K.

AU - Brown Brown, Calvin

AU - Bysani, G. Kris

AU - Cheifitz, Ira M.

AU - Emeriaud, Guillaume

AU - Gangadharan, Sandeep

AU - Giuliano Giuliano, John S.

AU - Howell, Joy D.

AU - Krawiec, Conrad

AU - Lee, Jan Hau

AU - Li, Simon

AU - Meyer, Keith

AU - Miksa, Michael

AU - Napolitano, Natalie

AU - Nett, Sholeen

AU - Nuthall, Gabrielle

AU - Orioles, Alberto

AU - Owen, Erin B.

AU - Parker, Margaret M.

AU - Parsons, Simon

AU - Polikoff, Lee A.

AU - Rehder, Kyle

AU - Saito, Osamu

AU - Sanders Sanders, Ronald C.

AU - Shenoi, Asha N.

AU - Simon, Dennis W.

AU - Skippen, Peter W.

AU - Tarquinio, Keiko

AU - Thompson, Anne

AU - Toedt-Pingel, Iris

AU - Vanderford, Paula

AU - Walson, Karen

AU - Nadkarni, Vinay

AU - Nishisaki, Akira

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Objectives: Evaluate differences in tracheal intubation–associated events and process variances (i.e., multiple intubation attempts and oxygen desaturation) between pediatric cardiac ICUs and noncardiac PICUs in children with underlying cardiac disease. Design: Retrospective cohort study using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children). Setting: Thirty-six PICUs (five cardiac ICUs, 31 noncardiac ICUs) from July 2012 to March 2016. Patients: Children with medical or surgical cardiac disease who underwent intubation in an ICU. Interventions: None. Measurements and Main Results: Our primary outcome was the rate of any adverse tracheal intubation–associated event. Secondary outcomes were severe tracheal intubation–associated events, multiple tracheal intubation attempt rates, and oxygen desaturation. There were 1,502 tracheal intubations in children with underlying cardiac disease (751 in cardiac ICUs, 751 in noncardiac ICUs) reported. Cardiac ICUs and noncardiac ICUs had similar proportions of patients with surgical cardiac disease. Patients undergoing intubation in cardiac ICUs were younger (median age, 1 mo [interquartile range, 0–6 mo]) compared with noncardiac ICUs (median 3 mo [interquartile range, 1–11 mo]; p < 0.001). Tracheal intubation–associated event rates were not different between cardiac ICUs and noncardiac ICUs (16% vs 19%; adjusted odds ratio, 0.74; 95% CI, 0.54–1.02; p = 0.069). However, in a sensitivity analysis comparing cardiac ICUs with mixed ICUs (i.e., ICUs caring for children with either general pediatric or cardiac diseases), cardiac ICUs had decreased odds of adverse events (adjusted odds ratio, 0.71; 95% CI, 0.52–0.97; p = 0.033). Rates of severe tracheal intubation–associated events and multiple attempts were similar. Desaturations occurred more often during intubation in cardiac ICUs (adjusted odds ratio, 1.61; 95% CI, 1.04–1.15; p = 0.002). Conclusions: In children with underlying cardiac disease, rates of adverse tracheal intubation–associated events were not lower in cardiac ICUs as compared to noncardiac ICUs, even after adjusting for differences in patient characteristics and care models.

AB - Objectives: Evaluate differences in tracheal intubation–associated events and process variances (i.e., multiple intubation attempts and oxygen desaturation) between pediatric cardiac ICUs and noncardiac PICUs in children with underlying cardiac disease. Design: Retrospective cohort study using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children). Setting: Thirty-six PICUs (five cardiac ICUs, 31 noncardiac ICUs) from July 2012 to March 2016. Patients: Children with medical or surgical cardiac disease who underwent intubation in an ICU. Interventions: None. Measurements and Main Results: Our primary outcome was the rate of any adverse tracheal intubation–associated event. Secondary outcomes were severe tracheal intubation–associated events, multiple tracheal intubation attempt rates, and oxygen desaturation. There were 1,502 tracheal intubations in children with underlying cardiac disease (751 in cardiac ICUs, 751 in noncardiac ICUs) reported. Cardiac ICUs and noncardiac ICUs had similar proportions of patients with surgical cardiac disease. Patients undergoing intubation in cardiac ICUs were younger (median age, 1 mo [interquartile range, 0–6 mo]) compared with noncardiac ICUs (median 3 mo [interquartile range, 1–11 mo]; p < 0.001). Tracheal intubation–associated event rates were not different between cardiac ICUs and noncardiac ICUs (16% vs 19%; adjusted odds ratio, 0.74; 95% CI, 0.54–1.02; p = 0.069). However, in a sensitivity analysis comparing cardiac ICUs with mixed ICUs (i.e., ICUs caring for children with either general pediatric or cardiac diseases), cardiac ICUs had decreased odds of adverse events (adjusted odds ratio, 0.71; 95% CI, 0.52–0.97; p = 0.033). Rates of severe tracheal intubation–associated events and multiple attempts were similar. Desaturations occurred more often during intubation in cardiac ICUs (adjusted odds ratio, 1.61; 95% CI, 1.04–1.15; p = 0.002). Conclusions: In children with underlying cardiac disease, rates of adverse tracheal intubation–associated events were not lower in cardiac ICUs as compared to noncardiac ICUs, even after adjusting for differences in patient characteristics and care models.

KW - cardiac arrest

KW - critical illness

KW - heart disease

KW - intubation

KW - pediatric critical care

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