Frequency of Desaturation and Association with Hemodynamic Adverse Events during Tracheal Intubations in PICUs

Simon Li, Ting Chang Hsieh, Kyle J. Rehder, Sholeen Nett, Pradip Kamat, Natalie Napolitano, David A. Turner, Michelle Adu-Darko, J. Dean Jarvis, Conrad Krawiec, Ashley T. Derbyshire, Keith Meyer, John S. Giuliano, Joana Tala, Keiko Tarquinio, Michael D. Ruppe, Ronald C. Sanders, Matthew Pinto, Joy D. Howell, Margaret M. ParkerGabrielle Nuthall, Michael Shepherd, Guillaume Emeriaud, Yuki Nagai, Osamu Saito, Jan Hau Lee, Dennis W. Simon, Alberto Orioles, Karen Walson, Paula Vanderford, Asha Shenoi, Anthony Lee, Geoffrey L. Bird, Michael Miksa, Ana Lia Graciano, Jesse Bain, Peter W. Skippen, Lee A. Polikoff, Vinay Nadkarni, Akira Nishisaki

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Objectives: Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association with adverse hemodynamic tracheal intubation-associated events. Design: Retrospective cohort study as a part of the National Emergency Airway Registry for Children Network's quality improvement project from January 2012 to December 2014. Setting: International PICUs. Patients: Critically ill children younger than 18 years undergoing primary tracheal intubations in the ICUs. Interventions: tracheal intubation processes of care and outcomes were prospectively collected using standardized operational definitions. We defined moderate desaturation as oxygen saturation less than 80% and severe desaturation as oxygen saturation less than 70% during tracheal intubation procedures in children with initial oxygen saturation greater than 90% after preoxygenation. Adverse hemodynamic tracheal intubation-associated event was defined as cardiac arrests, hypo or hypertension requiring intervention, and dysrhythmia. Measurements and Main Results: A total of 5,498 primary tracheal intubations from 31 ICUs were reported. Moderate desaturation was observed in 19.3% associated with adverse hemodynamic tracheal intubation-associated events (9.8% among children with moderate desaturation vs 4.4% without desaturation; p < 0.001). Severe desaturation was observed in 12.9% of tracheal intubations, also significantly associated with hemodynamic tracheal intubation-associated events. After adjusting for patient, provider, and practice factors, the occurrence of moderate desaturation was independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 1.83 (95% CI, 1.34-2.51; p < 0.001). The occurrence of severe desaturation was also independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 2.16 (95% CI, 1.54-3.04; p < 0.001). Number of tracheal intubation attempts was also significantly associated with the frequency of moderate and severe desaturations (p < 0.001). Conclusions: In this large tracheal intubation quality improvement database, we found moderate and severe desaturation are reported among 19% and 13% of all tracheal intubation encounters. Moderate and severe desaturations were independently associated with the occurrence of adverse hemodynamic events. Future quality improvement interventions may focus to reduce desaturation events.

Original languageEnglish (US)
Pages (from-to)e41-e50
JournalPediatric Critical Care Medicine
Volume19
Issue number1
DOIs
StatePublished - Jan 1 2018

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Intubation
Hemodynamics
Quality Improvement
Oxygen
Critical Illness
Odds Ratio
Heart Arrest
Registries
Emergencies
Cohort Studies

Keywords

  • desaturation
  • intensive care unit
  • oxygen
  • pediatric
  • tracheal intubation

ASJC Scopus subject areas

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

Cite this

Frequency of Desaturation and Association with Hemodynamic Adverse Events during Tracheal Intubations in PICUs. / Li, Simon; Hsieh, Ting Chang; Rehder, Kyle J.; Nett, Sholeen; Kamat, Pradip; Napolitano, Natalie; Turner, David A.; Adu-Darko, Michelle; Jarvis, J. Dean; Krawiec, Conrad; Derbyshire, Ashley T.; Meyer, Keith; Giuliano, John S.; Tala, Joana; Tarquinio, Keiko; Ruppe, Michael D.; Sanders, Ronald C.; Pinto, Matthew; Howell, Joy D.; Parker, Margaret M.; Nuthall, Gabrielle; Shepherd, Michael; Emeriaud, Guillaume; Nagai, Yuki; Saito, Osamu; Lee, Jan Hau; Simon, Dennis W.; Orioles, Alberto; Walson, Karen; Vanderford, Paula; Shenoi, Asha; Lee, Anthony; Bird, Geoffrey L.; Miksa, Michael; Graciano, Ana Lia; Bain, Jesse; Skippen, Peter W.; Polikoff, Lee A.; Nadkarni, Vinay; Nishisaki, Akira.

In: Pediatric Critical Care Medicine, Vol. 19, No. 1, 01.01.2018, p. e41-e50.

Research output: Contribution to journalReview article

Li, S, Hsieh, TC, Rehder, KJ, Nett, S, Kamat, P, Napolitano, N, Turner, DA, Adu-Darko, M, Jarvis, JD, Krawiec, C, Derbyshire, AT, Meyer, K, Giuliano, JS, Tala, J, Tarquinio, K, Ruppe, MD, Sanders, RC, Pinto, M, Howell, JD, Parker, MM, Nuthall, G, Shepherd, M, Emeriaud, G, Nagai, Y, Saito, O, Lee, JH, Simon, DW, Orioles, A, Walson, K, Vanderford, P, Shenoi, A, Lee, A, Bird, GL, Miksa, M, Graciano, AL, Bain, J, Skippen, PW, Polikoff, LA, Nadkarni, V & Nishisaki, A 2018, 'Frequency of Desaturation and Association with Hemodynamic Adverse Events during Tracheal Intubations in PICUs', Pediatric Critical Care Medicine, vol. 19, no. 1, pp. e41-e50. https://doi.org/10.1097/PCC.0000000000001384
Li, Simon ; Hsieh, Ting Chang ; Rehder, Kyle J. ; Nett, Sholeen ; Kamat, Pradip ; Napolitano, Natalie ; Turner, David A. ; Adu-Darko, Michelle ; Jarvis, J. Dean ; Krawiec, Conrad ; Derbyshire, Ashley T. ; Meyer, Keith ; Giuliano, John S. ; Tala, Joana ; Tarquinio, Keiko ; Ruppe, Michael D. ; Sanders, Ronald C. ; Pinto, Matthew ; Howell, Joy D. ; Parker, Margaret M. ; Nuthall, Gabrielle ; Shepherd, Michael ; Emeriaud, Guillaume ; Nagai, Yuki ; Saito, Osamu ; Lee, Jan Hau ; Simon, Dennis W. ; Orioles, Alberto ; Walson, Karen ; Vanderford, Paula ; Shenoi, Asha ; Lee, Anthony ; Bird, Geoffrey L. ; Miksa, Michael ; Graciano, Ana Lia ; Bain, Jesse ; Skippen, Peter W. ; Polikoff, Lee A. ; Nadkarni, Vinay ; Nishisaki, Akira. / Frequency of Desaturation and Association with Hemodynamic Adverse Events during Tracheal Intubations in PICUs. In: Pediatric Critical Care Medicine. 2018 ; Vol. 19, No. 1. pp. e41-e50.
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title = "Frequency of Desaturation and Association with Hemodynamic Adverse Events during Tracheal Intubations in PICUs",
abstract = "Objectives: Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association with adverse hemodynamic tracheal intubation-associated events. Design: Retrospective cohort study as a part of the National Emergency Airway Registry for Children Network's quality improvement project from January 2012 to December 2014. Setting: International PICUs. Patients: Critically ill children younger than 18 years undergoing primary tracheal intubations in the ICUs. Interventions: tracheal intubation processes of care and outcomes were prospectively collected using standardized operational definitions. We defined moderate desaturation as oxygen saturation less than 80{\%} and severe desaturation as oxygen saturation less than 70{\%} during tracheal intubation procedures in children with initial oxygen saturation greater than 90{\%} after preoxygenation. Adverse hemodynamic tracheal intubation-associated event was defined as cardiac arrests, hypo or hypertension requiring intervention, and dysrhythmia. Measurements and Main Results: A total of 5,498 primary tracheal intubations from 31 ICUs were reported. Moderate desaturation was observed in 19.3{\%} associated with adverse hemodynamic tracheal intubation-associated events (9.8{\%} among children with moderate desaturation vs 4.4{\%} without desaturation; p < 0.001). Severe desaturation was observed in 12.9{\%} of tracheal intubations, also significantly associated with hemodynamic tracheal intubation-associated events. After adjusting for patient, provider, and practice factors, the occurrence of moderate desaturation was independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 1.83 (95{\%} CI, 1.34-2.51; p < 0.001). The occurrence of severe desaturation was also independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 2.16 (95{\%} CI, 1.54-3.04; p < 0.001). Number of tracheal intubation attempts was also significantly associated with the frequency of moderate and severe desaturations (p < 0.001). Conclusions: In this large tracheal intubation quality improvement database, we found moderate and severe desaturation are reported among 19{\%} and 13{\%} of all tracheal intubation encounters. Moderate and severe desaturations were independently associated with the occurrence of adverse hemodynamic events. Future quality improvement interventions may focus to reduce desaturation events.",
keywords = "desaturation, intensive care unit, oxygen, pediatric, tracheal intubation",
author = "Simon Li and Hsieh, {Ting Chang} and Rehder, {Kyle J.} and Sholeen Nett and Pradip Kamat and Natalie Napolitano and Turner, {David A.} and Michelle Adu-Darko and Jarvis, {J. Dean} and Conrad Krawiec and Derbyshire, {Ashley T.} and Keith Meyer and Giuliano, {John S.} and Joana Tala and Keiko Tarquinio and Ruppe, {Michael D.} and Sanders, {Ronald C.} and Matthew Pinto and Howell, {Joy D.} and Parker, {Margaret M.} and Gabrielle Nuthall and Michael Shepherd and Guillaume Emeriaud and Yuki Nagai and Osamu Saito and Lee, {Jan Hau} and Simon, {Dennis W.} and Alberto Orioles and Karen Walson and Paula Vanderford and Asha Shenoi and Anthony Lee and Bird, {Geoffrey L.} and Michael Miksa and Graciano, {Ana Lia} and Jesse Bain and Skippen, {Peter W.} and Polikoff, {Lee A.} and Vinay Nadkarni and Akira Nishisaki",
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TY - JOUR

T1 - Frequency of Desaturation and Association with Hemodynamic Adverse Events during Tracheal Intubations in PICUs

AU - Li, Simon

AU - Hsieh, Ting Chang

AU - Rehder, Kyle J.

AU - Nett, Sholeen

AU - Kamat, Pradip

AU - Napolitano, Natalie

AU - Turner, David A.

AU - Adu-Darko, Michelle

AU - Jarvis, J. Dean

AU - Krawiec, Conrad

AU - Derbyshire, Ashley T.

AU - Meyer, Keith

AU - Giuliano, John S.

AU - Tala, Joana

AU - Tarquinio, Keiko

AU - Ruppe, Michael D.

AU - Sanders, Ronald C.

AU - Pinto, Matthew

AU - Howell, Joy D.

AU - Parker, Margaret M.

AU - Nuthall, Gabrielle

AU - Shepherd, Michael

AU - Emeriaud, Guillaume

AU - Nagai, Yuki

AU - Saito, Osamu

AU - Lee, Jan Hau

AU - Simon, Dennis W.

AU - Orioles, Alberto

AU - Walson, Karen

AU - Vanderford, Paula

AU - Shenoi, Asha

AU - Lee, Anthony

AU - Bird, Geoffrey L.

AU - Miksa, Michael

AU - Graciano, Ana Lia

AU - Bain, Jesse

AU - Skippen, Peter W.

AU - Polikoff, Lee A.

AU - Nadkarni, Vinay

AU - Nishisaki, Akira

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association with adverse hemodynamic tracheal intubation-associated events. Design: Retrospective cohort study as a part of the National Emergency Airway Registry for Children Network's quality improvement project from January 2012 to December 2014. Setting: International PICUs. Patients: Critically ill children younger than 18 years undergoing primary tracheal intubations in the ICUs. Interventions: tracheal intubation processes of care and outcomes were prospectively collected using standardized operational definitions. We defined moderate desaturation as oxygen saturation less than 80% and severe desaturation as oxygen saturation less than 70% during tracheal intubation procedures in children with initial oxygen saturation greater than 90% after preoxygenation. Adverse hemodynamic tracheal intubation-associated event was defined as cardiac arrests, hypo or hypertension requiring intervention, and dysrhythmia. Measurements and Main Results: A total of 5,498 primary tracheal intubations from 31 ICUs were reported. Moderate desaturation was observed in 19.3% associated with adverse hemodynamic tracheal intubation-associated events (9.8% among children with moderate desaturation vs 4.4% without desaturation; p < 0.001). Severe desaturation was observed in 12.9% of tracheal intubations, also significantly associated with hemodynamic tracheal intubation-associated events. After adjusting for patient, provider, and practice factors, the occurrence of moderate desaturation was independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 1.83 (95% CI, 1.34-2.51; p < 0.001). The occurrence of severe desaturation was also independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 2.16 (95% CI, 1.54-3.04; p < 0.001). Number of tracheal intubation attempts was also significantly associated with the frequency of moderate and severe desaturations (p < 0.001). Conclusions: In this large tracheal intubation quality improvement database, we found moderate and severe desaturation are reported among 19% and 13% of all tracheal intubation encounters. Moderate and severe desaturations were independently associated with the occurrence of adverse hemodynamic events. Future quality improvement interventions may focus to reduce desaturation events.

AB - Objectives: Oxygen desaturation during tracheal intubation is known to be associated with adverse ICU outcomes in critically ill children. We aimed to determine the occurrence and severity of desaturation during tracheal intubations and the association with adverse hemodynamic tracheal intubation-associated events. Design: Retrospective cohort study as a part of the National Emergency Airway Registry for Children Network's quality improvement project from January 2012 to December 2014. Setting: International PICUs. Patients: Critically ill children younger than 18 years undergoing primary tracheal intubations in the ICUs. Interventions: tracheal intubation processes of care and outcomes were prospectively collected using standardized operational definitions. We defined moderate desaturation as oxygen saturation less than 80% and severe desaturation as oxygen saturation less than 70% during tracheal intubation procedures in children with initial oxygen saturation greater than 90% after preoxygenation. Adverse hemodynamic tracheal intubation-associated event was defined as cardiac arrests, hypo or hypertension requiring intervention, and dysrhythmia. Measurements and Main Results: A total of 5,498 primary tracheal intubations from 31 ICUs were reported. Moderate desaturation was observed in 19.3% associated with adverse hemodynamic tracheal intubation-associated events (9.8% among children with moderate desaturation vs 4.4% without desaturation; p < 0.001). Severe desaturation was observed in 12.9% of tracheal intubations, also significantly associated with hemodynamic tracheal intubation-associated events. After adjusting for patient, provider, and practice factors, the occurrence of moderate desaturation was independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 1.83 (95% CI, 1.34-2.51; p < 0.001). The occurrence of severe desaturation was also independently associated with hemodynamic tracheal intubation-associated events: adjusted odds ratio 2.16 (95% CI, 1.54-3.04; p < 0.001). Number of tracheal intubation attempts was also significantly associated with the frequency of moderate and severe desaturations (p < 0.001). Conclusions: In this large tracheal intubation quality improvement database, we found moderate and severe desaturation are reported among 19% and 13% of all tracheal intubation encounters. Moderate and severe desaturations were independently associated with the occurrence of adverse hemodynamic events. Future quality improvement interventions may focus to reduce desaturation events.

KW - desaturation

KW - intensive care unit

KW - oxygen

KW - pediatric

KW - tracheal intubation

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M3 - Review article

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SP - e41-e50

JO - Pediatric Critical Care Medicine

JF - Pediatric Critical Care Medicine

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