Family presence during pediatric tracheal intubations

Ronald C. Sanders; Sholeen T. Nett; Katherine Finn Davis; Margaret M. Parker; G. Kris Bysani; Michelle Adu-Darko; Geoffrey L. Bird; Ira M. Cheifetz; Ashley T. Derbyshire; Guillaume Emeriaud; John S. Giuliano; Ana Lia Graciano; Yusuke Hagiwara; Glenda Hefley; Takanari Ikeyama; J. Dean Jarvis; Pradip Kamat; Ashwin S. Krishna; Anthony Lee; Jan Hau Lee; Simon Li; Keith Meyer; Vicki L. Montgomery; Yuki Nagai; Matthew Pinto; Kyle J. Rehder; Osamu Saito; Asha N. Shenoi; Hester Christianne Taekema; Keiko M. Tarquinio; Ann E. Thompson; David A. Turner; Vinay M. Nadkarni; Akira Nishisaki; Fasiha Saeed; Michael L. Forbes; Christopher Page-Goertz; Denise M. Goodman; Neethi Pinto; Nancy Jaimon; Heather Chandler; Joshua Salvin; Emily Levy; Jennifer Liedel; Michael Ushay; Edward Truemper; Andrea Talukdar; Nivedita Mohari; Malcolm Anderson; Barry Markovitz; Christopher Newth; Diana Pang; Timothy E. Bunchman; Michelle Hoot; Rainer Gedeit; Sheila Hanson; Darci Evans; Adam Schwarz; Nihal Godiwala; Matthew Sharron; Robert Russell; Margaret Winkler; Akria Nishisaki; Alexis F. Turgeon; Josee Larochelle; Sze Man Tse; Kelli Howard; Ranjit Chima; Leslie Lehmann; Christine Duncan; Lee Ann Christie; Renee Higgerson; James Fortenberry; Nina A. Guzzetta; Elizabeth Prentice; Brian Boville; Gwenn McLaughlin; Asumthia Jeyapalan; Sapna Kudchadkar; Kristen Nelson; Lauren Marsillio; Christopher Schneller; Roberta Adams; Grace Arteaga; Tracey Monjure; Jennifer McArthur; Kathy Murkowski; Fernando Beltramo; Rajinder Bajwa; Kathleen Nicol; Toah Nkromah; Debbie Spear; Eleanor Gradidge; David Tellez; Andrew Beardsley; Courtney Rowan; Felicia Su; Deborah Franzon; Margaret Packer; Robert I. Parker; Bhushan Katira; Steven Schwarz; Paula Silva; Yu Kawai; Matt Zinter; Natalie Z. Cvijanovich; Aline Maddux; Tellen Bennett; Julie S. Baines; Christian Kegg; Stacey Valentine; Scot Bateman; Nicole Zantek; Ashley Loomis; Martha A.Q. Curley; Robert Kapito; Jill M. Cholette; Louis Eugene Daugherty; Rebecca Dixon; Ellie Hirshberg; Scott Watson; Lincoln Smith; Philip C. Spinella; Allan Doctor; Emily Wasserman; Steven Pon; Abraar Quraishi; Ryan Breuer; Lee A. Polikoff; Josep Paniello; James Schneider; Katherine Biagas; Aileen Kirby

doi:10.1001/jamapediatrics.2015.4627

Family presence during pediatric tracheal intubations

Ronald C. Sanders, Sholeen T. Nett, Katherine Finn Davis, Margaret M. Parker, G. Kris Bysani, Michelle Adu-Darko, Geoffrey L. Bird, Ira M. Cheifetz, Ashley T. Derbyshire, Guillaume Emeriaud, John S. Giuliano, Ana Lia Graciano, Yusuke Hagiwara, Glenda Hefley, Takanari Ikeyama, J. Dean Jarvis, Pradip Kamat, Ashwin S. Krishna, Anthony Lee, Jan Hau LeeSimon Li, Keith Meyer, Vicki L. Montgomery, Yuki Nagai, Matthew Pinto, Kyle J. Rehder, Osamu Saito, Asha N. Shenoi, Hester Christianne Taekema, Keiko M. Tarquinio, Ann E. Thompson, David A. Turner, Vinay M. Nadkarni, Akira Nishisaki, Fasiha Saeed, Michael L. Forbes, Christopher Page-Goertz, Denise M. Goodman, Neethi Pinto, Nancy Jaimon, Heather Chandler, Joshua Salvin, Emily Levy, Jennifer Liedel, Michael Ushay, Edward Truemper, Andrea Talukdar, Nivedita Mohari, Malcolm Anderson, Barry Markovitz, Christopher Newth, Diana Pang, Timothy E. Bunchman, Michelle Hoot, Rainer Gedeit, Sheila Hanson, Darci Evans, Adam Schwarz, Nihal Godiwala, Matthew Sharron, Robert Russell, Margaret Winkler, Akria Nishisaki, Alexis F. Turgeon, Josee Larochelle, Sze Man Tse, Kelli Howard, Ranjit Chima, Leslie Lehmann, Christine Duncan, Lee Ann Christie, Renee Higgerson, James Fortenberry, Nina A. Guzzetta, Elizabeth Prentice, Brian Boville, Gwenn McLaughlin, Asumthia Jeyapalan, Sapna Kudchadkar, Kristen Nelson, Lauren Marsillio, Christopher Schneller, Roberta Adams, Grace Arteaga, Tracey Monjure, Jennifer McArthur, Kathy Murkowski, Fernando Beltramo, Rajinder Bajwa, Kathleen Nicol, Toah Nkromah, Debbie Spear, Eleanor Gradidge, David Tellez, Andrew Beardsley, Courtney Rowan, Felicia Su, Deborah Franzon, Margaret Packer, Robert I. Parker, Bhushan Katira, Steven Schwarz, Paula Silva, Yu Kawai, Matt Zinter, Natalie Z. Cvijanovich, Aline Maddux, Tellen Bennett, Julie S. Baines, Christian Kegg, Stacey Valentine, Scot Bateman, Nicole Zantek, Ashley Loomis, Martha A.Q. Curley, Robert Kapito, Jill M. Cholette, Louis Eugene Daugherty, Rebecca Dixon, Ellie Hirshberg, Scott Watson, Lincoln Smith, Philip C. Spinella, Allan Doctor, Emily Wasserman, Steven Pon, Abraar Quraishi, Ryan Breuer, Lee A. Polikoff, Josep Paniello, James Schneider, Katherine Biagas, Aileen Kirby

Pediatrics

Research output: Contribution to journal › Article › peer-review

20 Scopus citations

Abstract

IMPORTANCE: Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal intubation (TI) in pediatric intensive care units (PICUs). Family presence during procedures in PICUs has been advocated. OBJECTIVE: To describe the current practice of FP during TI and evaluate the association with procedural and clinician (including physician, respiratory therapist, and nurse practitioner) outcomes across multiple PICUs. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study in which all TIs from July 2010 to March 2014 in the multicenter TI database (National Emergency Airway Registry for Children [NEAR4KIDS]) were analyzed. Family presence was defined as a family member present during TI. This study included all TIs in patients younger than 18 years in 22 international PICUs. EXPOSURES: Family presence and no FP during TI in the PICU. MAIN OUTCOMES AND MEASURES: The percentage of FP during TIs. First attempt success rate, adverse TI-associated events, multiple attempts (≥3), oxygen desaturation (oxygen saturation as measured by pulse oximetry <80%), and self-reported team stress level. RESULTS: Atotal of 4969 TI encounters were reported. Amongthose, 81% (n = 4030) of TIs had documented FP status (with/without). The median age of participants with FP was 2 years and 1 year for those without FP. The average percentage of TIs with FP was 19% and varied widely across sites (0%-43%; P < .001). Tracheal intubations with FP (vs without FP) were associated with older patients (median, 2 years vs 1 year; P = .04), lower Paediatric Index of Mortality 2 score, and pediatric resident as the first airway clinician (23%, n = 179 vs 18%, n = 584; odds ratio [OR], 1.4; 95% CI, 1.2-1.7). Tracheal intubations with FP and without FP were no different in the first attempt success rate (OR, 1.00; 95% CI, 0.85-1.18), adverse TI-associated events (any events: OR, 1.06; 95% CI, 0.85-1.30 and severe events: OR, 1.04; 95% CI, 0.75-1.43), multiple attempts (≥3) (OR, 1.03; 95% CI, 0.82-1.28), oxygen desaturation (oxygen saturation <80%) (OR, 0.97; 95% CI, 0.80-1.18), or self-reported team stress level (OR, 1.09; 95% CI, 0.92-1.31). This result persisted after adjusting for patient and clinician confounders. CONCLUSIONS AND RELEVANCE: Wide variability exists in FP during TIs across PICUs. Family presence was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (<80%), or higher team stress level. Our data suggest that FP during TI can safely be implemented as part of a family-centered care model in the PICU.

Original language	English (US)
Article number	4627
Journal	JAMA Pediatrics
Volume	170
Issue number	3
DOIs	https://doi.org/10.1001/jamapediatrics.2015.4627
State	Published - Mar 2016

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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10.1001/jamapediatrics.2015.4627

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Sanders, R. C., Nett, S. T., Davis, K. F., Parker, M. M., Bysani, G. K., Adu-Darko, M., Bird, G. L., Cheifetz, I. M., Derbyshire, A. T., Emeriaud, G., Giuliano, J. S., Graciano, A. L., Hagiwara, Y., Hefley, G., Ikeyama, T., Jarvis, J. D., Kamat, P., Krishna, A. S., Lee, A., ... Kirby, A. (2016). Family presence during pediatric tracheal intubations. JAMA Pediatrics, 170(3), Article 4627. https://doi.org/10.1001/jamapediatrics.2015.4627

Sanders, RC, Nett, ST, Davis, KF, Parker, MM, Bysani, GK, Adu-Darko, M, Bird, GL, Cheifetz, IM, Derbyshire, AT, Emeriaud, G, Giuliano, JS, Graciano, AL, Hagiwara, Y, Hefley, G, Ikeyama, T, Jarvis, JD, Kamat, P, Krishna, AS, Lee, A, Lee, JH, Li, S, Meyer, K, Montgomery, VL, Nagai, Y, Pinto, M, Rehder, KJ, Saito, O, Shenoi, AN, Taekema, HC, Tarquinio, KM, Thompson, AE, Turner, DA, Nadkarni, VM, Nishisaki, A, Saeed, F, Forbes, ML, Page-Goertz, C, Goodman, DM, Pinto, N, Jaimon, N, Chandler, H, Salvin, J, Levy, E, Liedel, J, Ushay, M, Truemper, E, Talukdar, A, Mohari, N, Anderson, M, Markovitz, B, Newth, C, Pang, D, Bunchman, TE, Hoot, M, Gedeit, R, Hanson, S, Evans, D, Schwarz, A, Godiwala, N, Sharron, M, Russell, R, Winkler, M, Nishisaki, A, Turgeon, AF, Larochelle, J, Tse, SM, Howard, K, Chima, R, Lehmann, L, Duncan, C, Christie, LA, Higgerson, R, Fortenberry, J, Guzzetta, NA, Prentice, E, Boville, B, McLaughlin, G, Jeyapalan, A, Kudchadkar, S, Nelson, K, Marsillio, L, Schneller, C, Adams, R, Arteaga, G, Monjure, T, McArthur, J, Murkowski, K, Beltramo, F, Bajwa, R, Nicol, K, Nkromah, T, Spear, D, Gradidge, E, Tellez, D, Beardsley, A, Rowan, C, Su, F, Franzon, D, Packer, M, Parker, RI, Katira, B, Schwarz, S, Silva, P, Kawai, Y, Zinter, M, Cvijanovich, NZ, Maddux, A, Bennett, T, Baines, JS, Kegg, C, Valentine, S, Bateman, S, Zantek, N, Loomis, A, Curley, MAQ, Kapito, R, Cholette, JM, Daugherty, LE, Dixon, R, Hirshberg, E, Watson, S, Smith, L, Spinella, PC, Doctor, A, Wasserman, E, Pon, S, Quraishi, A, Breuer, R, Polikoff, LA, Paniello, J, Schneider, J, Biagas, K & Kirby, A 2016, 'Family presence during pediatric tracheal intubations', JAMA Pediatrics, vol. 170, no. 3, 4627. https://doi.org/10.1001/jamapediatrics.2015.4627

@article{56b2e19da01b4e8fbf80afe954514e04,

title = "Family presence during pediatric tracheal intubations",

abstract = "IMPORTANCE: Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal intubation (TI) in pediatric intensive care units (PICUs). Family presence during procedures in PICUs has been advocated. OBJECTIVE: To describe the current practice of FP during TI and evaluate the association with procedural and clinician (including physician, respiratory therapist, and nurse practitioner) outcomes across multiple PICUs. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study in which all TIs from July 2010 to March 2014 in the multicenter TI database (National Emergency Airway Registry for Children [NEAR4KIDS]) were analyzed. Family presence was defined as a family member present during TI. This study included all TIs in patients younger than 18 years in 22 international PICUs. EXPOSURES: Family presence and no FP during TI in the PICU. MAIN OUTCOMES AND MEASURES: The percentage of FP during TIs. First attempt success rate, adverse TI-associated events, multiple attempts (≥3), oxygen desaturation (oxygen saturation as measured by pulse oximetry <80%), and self-reported team stress level. RESULTS: Atotal of 4969 TI encounters were reported. Amongthose, 81% (n = 4030) of TIs had documented FP status (with/without). The median age of participants with FP was 2 years and 1 year for those without FP. The average percentage of TIs with FP was 19% and varied widely across sites (0%-43%; P < .001). Tracheal intubations with FP (vs without FP) were associated with older patients (median, 2 years vs 1 year; P = .04), lower Paediatric Index of Mortality 2 score, and pediatric resident as the first airway clinician (23%, n = 179 vs 18%, n = 584; odds ratio [OR], 1.4; 95% CI, 1.2-1.7). Tracheal intubations with FP and without FP were no different in the first attempt success rate (OR, 1.00; 95% CI, 0.85-1.18), adverse TI-associated events (any events: OR, 1.06; 95% CI, 0.85-1.30 and severe events: OR, 1.04; 95% CI, 0.75-1.43), multiple attempts (≥3) (OR, 1.03; 95% CI, 0.82-1.28), oxygen desaturation (oxygen saturation <80%) (OR, 0.97; 95% CI, 0.80-1.18), or self-reported team stress level (OR, 1.09; 95% CI, 0.92-1.31). This result persisted after adjusting for patient and clinician confounders. CONCLUSIONS AND RELEVANCE: Wide variability exists in FP during TIs across PICUs. Family presence was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (<80%), or higher team stress level. Our data suggest that FP during TI can safely be implemented as part of a family-centered care model in the PICU.",

author = "Sanders, {Ronald C.} and Nett, {Sholeen T.} and Davis, {Katherine Finn} and Parker, {Margaret M.} and Bysani, {G. Kris} and Michelle Adu-Darko and Bird, {Geoffrey L.} and Cheifetz, {Ira M.} and Derbyshire, {Ashley T.} and Guillaume Emeriaud and Giuliano, {John S.} and Graciano, {Ana Lia} and Yusuke Hagiwara and Glenda Hefley and Takanari Ikeyama and Jarvis, {J. Dean} and Pradip Kamat and Krishna, {Ashwin S.} and Anthony Lee and Lee, {Jan Hau} and Simon Li and Keith Meyer and Montgomery, {Vicki L.} and Yuki Nagai and Matthew Pinto and Rehder, {Kyle J.} and Osamu Saito and Shenoi, {Asha N.} and Taekema, {Hester Christianne} and Tarquinio, {Keiko M.} and Thompson, {Ann E.} and Turner, {David A.} and Nadkarni, {Vinay M.} and Akira Nishisaki and Fasiha Saeed and Forbes, {Michael L.} and Christopher Page-Goertz and Goodman, {Denise M.} and Neethi Pinto and Nancy Jaimon and Heather Chandler and Joshua Salvin and Emily Levy and Jennifer Liedel and Michael Ushay and Edward Truemper and Andrea Talukdar and Nivedita Mohari and Malcolm Anderson and Barry Markovitz and Christopher Newth and Diana Pang and Bunchman, {Timothy E.} and Michelle Hoot and Rainer Gedeit and Sheila Hanson and Darci Evans and Adam Schwarz and Nihal Godiwala and Matthew Sharron and Robert Russell and Margaret Winkler and Akria Nishisaki and Turgeon, {Alexis F.} and Josee Larochelle and Tse, {Sze Man} and Kelli Howard and Ranjit Chima and Leslie Lehmann and Christine Duncan and Christie, {Lee Ann} and Renee Higgerson and James Fortenberry and Guzzetta, {Nina A.} and Elizabeth Prentice and Brian Boville and Gwenn McLaughlin and Asumthia Jeyapalan and Sapna Kudchadkar and Kristen Nelson and Lauren Marsillio and Christopher Schneller and Roberta Adams and Grace Arteaga and Tracey Monjure and Jennifer McArthur and Kathy Murkowski and Fernando Beltramo and Rajinder Bajwa and Kathleen Nicol and Toah Nkromah and Debbie Spear and Eleanor Gradidge and David Tellez and Andrew Beardsley and Courtney Rowan and Felicia Su and Deborah Franzon and Margaret Packer and Parker, {Robert I.} and Bhushan Katira and Steven Schwarz and Paula Silva and Yu Kawai and Matt Zinter and Cvijanovich, {Natalie Z.} and Aline Maddux and Tellen Bennett and Baines, {Julie S.} and Christian Kegg and Stacey Valentine and Scot Bateman and Nicole Zantek and Ashley Loomis and Curley, {Martha A.Q.} and Robert Kapito and Cholette, {Jill M.} and Daugherty, {Louis Eugene} and Rebecca Dixon and Ellie Hirshberg and Scott Watson and Lincoln Smith and Spinella, {Philip C.} and Allan Doctor and Emily Wasserman and Steven Pon and Abraar Quraishi and Ryan Breuer and Polikoff, {Lee A.} and Josep Paniello and James Schneider and Katherine Biagas and Aileen Kirby",

year = "2016",

month = mar,

doi = "10.1001/jamapediatrics.2015.4627",

language = "English (US)",

volume = "170",

journal = "JAMA Pediatrics",

issn = "2168-6203",

publisher = "American Medical Association",

number = "3",

}

TY - JOUR

T1 - Family presence during pediatric tracheal intubations

AU - Sanders, Ronald C.

AU - Nett, Sholeen T.

AU - Davis, Katherine Finn

AU - Parker, Margaret M.

AU - Bysani, G. Kris

AU - Adu-Darko, Michelle

AU - Bird, Geoffrey L.

AU - Cheifetz, Ira M.

AU - Derbyshire, Ashley T.

AU - Emeriaud, Guillaume

AU - Giuliano, John S.

AU - Graciano, Ana Lia

AU - Hagiwara, Yusuke

AU - Hefley, Glenda

AU - Ikeyama, Takanari

AU - Jarvis, J. Dean

AU - Kamat, Pradip

AU - Krishna, Ashwin S.

AU - Lee, Anthony

AU - Lee, Jan Hau

AU - Li, Simon

AU - Meyer, Keith

AU - Montgomery, Vicki L.

AU - Nagai, Yuki

AU - Pinto, Matthew

AU - Rehder, Kyle J.

AU - Saito, Osamu

AU - Shenoi, Asha N.

AU - Taekema, Hester Christianne

AU - Tarquinio, Keiko M.

AU - Thompson, Ann E.

AU - Turner, David A.

AU - Nadkarni, Vinay M.

AU - Nishisaki, Akira

AU - Saeed, Fasiha

AU - Forbes, Michael L.

AU - Page-Goertz, Christopher

AU - Goodman, Denise M.

AU - Pinto, Neethi

AU - Jaimon, Nancy

AU - Chandler, Heather

AU - Salvin, Joshua

AU - Levy, Emily

AU - Liedel, Jennifer

AU - Ushay, Michael

AU - Truemper, Edward

AU - Talukdar, Andrea

AU - Mohari, Nivedita

AU - Anderson, Malcolm

AU - Markovitz, Barry

AU - Newth, Christopher

AU - Pang, Diana

AU - Bunchman, Timothy E.

AU - Hoot, Michelle

AU - Gedeit, Rainer

AU - Hanson, Sheila

AU - Evans, Darci

AU - Schwarz, Adam

AU - Godiwala, Nihal

AU - Sharron, Matthew

AU - Russell, Robert

AU - Winkler, Margaret

AU - Nishisaki, Akria

AU - Turgeon, Alexis F.

AU - Larochelle, Josee

AU - Tse, Sze Man

AU - Howard, Kelli

AU - Chima, Ranjit

AU - Lehmann, Leslie

AU - Duncan, Christine

AU - Christie, Lee Ann

AU - Higgerson, Renee

AU - Fortenberry, James

AU - Guzzetta, Nina A.

AU - Prentice, Elizabeth

AU - Boville, Brian

AU - McLaughlin, Gwenn

AU - Jeyapalan, Asumthia

AU - Kudchadkar, Sapna

AU - Nelson, Kristen

AU - Marsillio, Lauren

AU - Schneller, Christopher

AU - Adams, Roberta

AU - Arteaga, Grace

AU - Monjure, Tracey

AU - McArthur, Jennifer

AU - Murkowski, Kathy

AU - Beltramo, Fernando

AU - Bajwa, Rajinder

AU - Nicol, Kathleen

AU - Nkromah, Toah

AU - Spear, Debbie

AU - Gradidge, Eleanor

AU - Tellez, David

AU - Beardsley, Andrew

AU - Rowan, Courtney

AU - Su, Felicia

AU - Franzon, Deborah

AU - Packer, Margaret

AU - Parker, Robert I.

AU - Katira, Bhushan

AU - Schwarz, Steven

AU - Silva, Paula

AU - Kawai, Yu

AU - Zinter, Matt

AU - Cvijanovich, Natalie Z.

AU - Maddux, Aline

AU - Bennett, Tellen

AU - Baines, Julie S.

AU - Kegg, Christian

AU - Valentine, Stacey

AU - Bateman, Scot

AU - Zantek, Nicole

AU - Loomis, Ashley

AU - Curley, Martha A.Q.

AU - Kapito, Robert

AU - Cholette, Jill M.

AU - Daugherty, Louis Eugene

AU - Dixon, Rebecca

AU - Hirshberg, Ellie

AU - Watson, Scott

AU - Smith, Lincoln

AU - Spinella, Philip C.

AU - Doctor, Allan

AU - Wasserman, Emily

AU - Pon, Steven

AU - Quraishi, Abraar

AU - Breuer, Ryan

AU - Polikoff, Lee A.

AU - Paniello, Josep

AU - Schneider, James

AU - Biagas, Katherine

AU - Kirby, Aileen

PY - 2016/3

Y1 - 2016/3

N2 - IMPORTANCE: Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal intubation (TI) in pediatric intensive care units (PICUs). Family presence during procedures in PICUs has been advocated. OBJECTIVE: To describe the current practice of FP during TI and evaluate the association with procedural and clinician (including physician, respiratory therapist, and nurse practitioner) outcomes across multiple PICUs. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study in which all TIs from July 2010 to March 2014 in the multicenter TI database (National Emergency Airway Registry for Children [NEAR4KIDS]) were analyzed. Family presence was defined as a family member present during TI. This study included all TIs in patients younger than 18 years in 22 international PICUs. EXPOSURES: Family presence and no FP during TI in the PICU. MAIN OUTCOMES AND MEASURES: The percentage of FP during TIs. First attempt success rate, adverse TI-associated events, multiple attempts (≥3), oxygen desaturation (oxygen saturation as measured by pulse oximetry <80%), and self-reported team stress level. RESULTS: Atotal of 4969 TI encounters were reported. Amongthose, 81% (n = 4030) of TIs had documented FP status (with/without). The median age of participants with FP was 2 years and 1 year for those without FP. The average percentage of TIs with FP was 19% and varied widely across sites (0%-43%; P < .001). Tracheal intubations with FP (vs without FP) were associated with older patients (median, 2 years vs 1 year; P = .04), lower Paediatric Index of Mortality 2 score, and pediatric resident as the first airway clinician (23%, n = 179 vs 18%, n = 584; odds ratio [OR], 1.4; 95% CI, 1.2-1.7). Tracheal intubations with FP and without FP were no different in the first attempt success rate (OR, 1.00; 95% CI, 0.85-1.18), adverse TI-associated events (any events: OR, 1.06; 95% CI, 0.85-1.30 and severe events: OR, 1.04; 95% CI, 0.75-1.43), multiple attempts (≥3) (OR, 1.03; 95% CI, 0.82-1.28), oxygen desaturation (oxygen saturation <80%) (OR, 0.97; 95% CI, 0.80-1.18), or self-reported team stress level (OR, 1.09; 95% CI, 0.92-1.31). This result persisted after adjusting for patient and clinician confounders. CONCLUSIONS AND RELEVANCE: Wide variability exists in FP during TIs across PICUs. Family presence was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (<80%), or higher team stress level. Our data suggest that FP during TI can safely be implemented as part of a family-centered care model in the PICU.

AB - IMPORTANCE: Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal intubation (TI) in pediatric intensive care units (PICUs). Family presence during procedures in PICUs has been advocated. OBJECTIVE: To describe the current practice of FP during TI and evaluate the association with procedural and clinician (including physician, respiratory therapist, and nurse practitioner) outcomes across multiple PICUs. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study in which all TIs from July 2010 to March 2014 in the multicenter TI database (National Emergency Airway Registry for Children [NEAR4KIDS]) were analyzed. Family presence was defined as a family member present during TI. This study included all TIs in patients younger than 18 years in 22 international PICUs. EXPOSURES: Family presence and no FP during TI in the PICU. MAIN OUTCOMES AND MEASURES: The percentage of FP during TIs. First attempt success rate, adverse TI-associated events, multiple attempts (≥3), oxygen desaturation (oxygen saturation as measured by pulse oximetry <80%), and self-reported team stress level. RESULTS: Atotal of 4969 TI encounters were reported. Amongthose, 81% (n = 4030) of TIs had documented FP status (with/without). The median age of participants with FP was 2 years and 1 year for those without FP. The average percentage of TIs with FP was 19% and varied widely across sites (0%-43%; P < .001). Tracheal intubations with FP (vs without FP) were associated with older patients (median, 2 years vs 1 year; P = .04), lower Paediatric Index of Mortality 2 score, and pediatric resident as the first airway clinician (23%, n = 179 vs 18%, n = 584; odds ratio [OR], 1.4; 95% CI, 1.2-1.7). Tracheal intubations with FP and without FP were no different in the first attempt success rate (OR, 1.00; 95% CI, 0.85-1.18), adverse TI-associated events (any events: OR, 1.06; 95% CI, 0.85-1.30 and severe events: OR, 1.04; 95% CI, 0.75-1.43), multiple attempts (≥3) (OR, 1.03; 95% CI, 0.82-1.28), oxygen desaturation (oxygen saturation <80%) (OR, 0.97; 95% CI, 0.80-1.18), or self-reported team stress level (OR, 1.09; 95% CI, 0.92-1.31). This result persisted after adjusting for patient and clinician confounders. CONCLUSIONS AND RELEVANCE: Wide variability exists in FP during TIs across PICUs. Family presence was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (<80%), or higher team stress level. Our data suggest that FP during TI can safely be implemented as part of a family-centered care model in the PICU.

UR - http://www.scopus.com/inward/record.url?scp=84962393708&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84962393708&partnerID=8YFLogxK

U2 - 10.1001/jamapediatrics.2015.4627

DO - 10.1001/jamapediatrics.2015.4627

M3 - Article

C2 - 26954533

AN - SCOPUS:84962393708

SN - 2168-6203

VL - 170

JO - JAMA Pediatrics

JF - JAMA Pediatrics

IS - 3

M1 - 4627

ER -

Family presence during pediatric tracheal intubations

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