PDF herunterladen
J Pediatr Intensive Care
DOI: 10.1055/s-0044-1787858
Original Article

Harms Associated with Tracheal Reintubation After Unplanned Extubation: A Retrospective Cohort Study

Mathew P. Malone 
1   Division of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, United States
,
Ilana Harwayne-Gidansky
2   Division of Critical Care Medicine, Department of Pediatrics, Albany Medical Center, Albany, New York, United States
,
Ronald C. Sanders Jr.
1   Division of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, United States
,
Natalie Napolitano
3   Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Jennifer Pham
4   Division of Critical Care Medicine, Department of Pediatrics, Sunrise Children's Hospital, Las Vegas, Nevada, United States
,
Lee Polikoff
5   Division of Critical Care Medicine, Department of Pediatrics, Brown University, Providence, Rhode Island, United States
,
Melinda Register
6   Department of Respiratory Care, Children's Healthcare of Atlanta, Egleston, Atlanta, Georgia, United States
,
Keiko M. Tarquinio
6   Department of Respiratory Care, Children's Healthcare of Atlanta, Egleston, Atlanta, Georgia, United States
7   Division of Critical Care Medicine, Department of Pediatrics, Emory University, Atlanta, Georgia, United States
,
Justine Shults
8   Division of Biostatistics, Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Conrad Krawiec
9   Division of Pediatric Critical Care, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania, United States
,
Palen Mallory
10   Division of Critical Care Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, United States
,
Ryan K. Breuer
11   Division of Critical Care Medicine, Department of Pediatrics, University at Buffalo, Buffalo, New York, United States
,
Asha N. Shenoi
12   Division of Critical Care Medicine, Department of Pediatrics, University of Kentucky School of Medicine, Lexington, Kentucky, United States
,
Krista Wollny
13   Faculty of Nursing, University of Calgary, Calgary, Canada
,
Simon J. Parsons
14   Division of Critical Care, Alberta Children's Hospital, Alberta, Calgary, Canada
,
Sarah B. Kandil
15   Department of Pediatrics, Critical Care Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
,
Matthew Pinto
16   Department of Pediatrics, Maria Fareri Children's Hospital, Valhalla, New York, United States
,
Kelsey M. Gladen
17   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, Arizona, United States
,
Maya Dewan
18   Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States
,
Ana Lia Graciano
19   Department of Pediatrics, Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
,
Sholeen Nett
20   Division of Critical Care Medicine, Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
21   Baystate Children's Hospital, Springfield, Massachusetts, United States
,
John S. Giuliano
15   Department of Pediatrics, Critical Care Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
,
Ashwin S. Krishna
12   Division of Critical Care Medicine, Department of Pediatrics, University of Kentucky School of Medicine, Lexington, Kentucky, United States
,
Laurence Ducharme-Crevier
22   Pediatric Intensive Care Unit, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
,
Andrea Talukdar
23   Division of Critical Care Medicine, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Jan Hau Lee
24   Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
,
Michael Miksa
25   Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York, United States
,
Anthony Lee
26   Division of Critical Care Medicine, The Ohio State University College of Medicine, Columbus, Ohio, United States
,
Aziez Ahmed
15   Department of Pediatrics, Critical Care Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
,
Christopher Page-Goertz
27   Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio, United States
,
Philipp Jung
28   Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
,
Briana L. Scott
10   Division of Critical Care Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, United States
,
Serena P. Kelly
29   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Oregon Health and Science University/Doernbecher Children's Hospital, Portland, Oregon, United States
,
Awni Al-Subu
30   Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Debbie Spear
9   Division of Pediatric Critical Care, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania, United States
,
Lauren Allen
10   Division of Critical Care Medicine, Department of Pediatrics, Duke University, Durham, North Carolina, United States
,
Johnna Sizemore
31   Division of Pediatric Critical Care Medicine, University of Louisville/Norton Children's Hospital, Louisville, Kentucky, United States
,
Mioko Kasagi
32   Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
,
Yuki Nagai
33   Division of Pediatric Critical Care Medicine, Kobe Children's Hospital, Kobe, Hyogo, Japan
,
Megan Toal
34   Division of Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States
,
Katherine Biagas
35   Division of Critical Care Medicine, Department of Pediatrics, The Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
,
Vinay Nadkarni
36   Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Akira Nishisaki
36   Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
for the National Emergency Airway Registry for Children (NEAR4KIDS) Pediatric Acute Lung Injury Sepsis Investigators (PALISI) Network› Institutsangaben
Funding This study was supported by AHRQ R18HS024511. N.N., J.S., V.N., and A.N. were supported by AHRQ R18HS024511. Other authors disclosed no other funding sources.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Objective This study evaluates the clinical harm associated with tracheal intubation (TI) after unplanned extubation (UE) in the pediatric intensive care unit (ICU). We hypothesized that TI after UE is associated with a higher risk of adverse airway outcomes (AAOs), including peri-intubation hypoxia.

Methods A total of 23,320 TIs from 59 ICUs in patients aged 0 to 17 years from 2014 to 2020 from the National Emergency Airway Registry for Children (NEAR4KIDS) database were evaluated. AAO was defined as any adverse TI-associated event and/or peri-intubation hypoxia (SpO2 < 80%). UE trends were assessed over time. A multivariable logistic regression model was developed to evaluate the association between UE and AAO, while controlling for patient, provider, and practice confounders.

Results UE was reported as TI indication in 373 (1.6%) patients, with the proportion increasing over time: 0.1% in 2014 to 2.8% in 2020 (p < 0.001). TIs after UE versus TIs without preceding UE were more common in infants (62 vs. 48%, p < 0.001), males (63 vs. 56%, p = 0.003), and children with a history of difficult airway (17 vs. 13%, p = 0.03). After controlling for potential confounders, TI after UE was not significantly associated with AAO (adjusted odds ratio [aOR]: 1.26, 95% confidence interval [CI]: 0.99–1.62, p = 0.06). However, TI after UE was significantly associated with peri-intubation hypoxia (aOR: 1.35, 95% CI: 1.02–1.79, p = 0.03).

Conclusions UE is increasing as an indication for TI, and is more common in infants and children with a history of difficult airway. As TI after UE was associated with increased peri-intubation hypoxia, future study should focus on identifying causality and mitigating peri-intubation risk.

Keywords

pediatric - NEAR4KIDS - unplanned extubation - intubation - PICU

Note

This abstract was presented as an invited Oral Presentation at the 2022 Critical Care Congress, April 18–21, 2022, virtual.




Publikationsverlauf

Eingereicht: 18. September 2023

Angenommen: 26. Mai 2024

Artikel online veröffentlicht:
10. Juli 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Kapadia FN, Bajan KB, Raje KV. Airway accidents in intubated intensive care unit patients: an epidemiological study. Crit Care Med 2000; 28 (03) 659-664
    CrossrefPubMedSuche in Google Scholar
  • 2 Klugman D, Melton K, Maynord PO. et al. Assessment of an unplanned extubation bundle to reduce unplanned extubations in critically ill neonates, infants, and children. JAMA Pediatr 2020; 174 (06) e200268
    CrossrefPubMedSuche in Google Scholar
  • 3 Melton K, Ryan C, Saunders A, Zix J. Reducing pediatric unplanned extubation across multiple ICUs using quality improvement. Pediatrics 2022; 149 (05) e2021052259
    CrossrefPubMedSuche in Google Scholar
  • 4 Tripathi S, Nunez DJ, Katyal C, Ushay HM. Plan to have no unplanned: a collaborative, hospital-based quality-improvement project to reduce the rate of unplanned extubations in the pediatric ICU. Respir Care 2015; 60 (08) 1105-1112
    CrossrefPubMedSuche in Google Scholar
  • 5 Kanthimathinathan HK, Durward A, Nyman A, Murdoch IA, Tibby SM. Unplanned extubation in a paediatric intensive care unit: prospective cohort study. Intensive Care Med 2015; 41 (07) 1299-1306
    CrossrefPubMedSuche in Google Scholar
  • 6 Al-Abdwani R, Williams CB, Dunn C. et al. Incidence, outcomes and outcome prediction of unplanned extubation in critically ill children: an 11year experience. J Crit Care 2018; 44: 368-375
    CrossrefPubMedSuche in Google Scholar
  • 7 Roddy DJ, Spaeder MC, Pastor W, Stockwell DC, Klugman D. Unplanned extubations in children: impact on hospital cost and length of stay. Pediatr Crit Care Med 2015; 16 (06) 572-575
    CrossrefPubMedSuche in Google Scholar
  • 8 Rachman BR, Mink RB. A prospective observational quality improvement study of the sustained effects of a program to reduce unplanned extubations in a pediatric intensive care unit. Paediatr Anaesth 2013; 23 (07) 614-620
    CrossrefPubMedSuche in Google Scholar
  • 9 Parker MM, Nuthall G, Brown III C. et al; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Relationship between adverse tracheal intubation associated events and PICU outcomes. Pediatr Crit Care Med 2017; 18 (04) 310-318
    CrossrefPubMedSuche in Google Scholar
  • 10 Rehder KJ, Giuliano Jr JS, Napolitano N. et al; National Emergency Airway Registry for Children and Pediatric Acute Lung Injury and Sepsis Investigators. Increased occurrence of tracheal intubation-associated events during nights and weekends in the PICU. Crit Care Med 2015; 43 (12) 2668-2674
    CrossrefPubMedSuche in Google Scholar
  • 11 Sanders Jr RC, Giuliano Jr JS, Sullivan JE. et al; National Emergency Airway Registry for Children Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Level of trainee and tracheal intubation outcomes. Pediatrics 2013; 131 (03) e821-e828
    CrossrefPubMedSuche in Google Scholar
  • 12 Nishisaki A, Turner DA, Brown III CA, Walls RM, Nadkarni VM. National Emergency Airway Registry for Children (NEAR4KIDS), Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. A National Emergency Airway Registry for children: landscape of tracheal intubation in 15 PICUs. Crit Care Med 2013; 41 (03) 874-885
    CrossrefPubMedSuche in Google Scholar
  • 13 Blackwood B, Tume LN, Morris KP. et al; SANDWICH Collaborators. Effect of a sedation and ventilator liberation protocol vs usual care on duration of invasive mechanical ventilation in pediatric intensive care units: a randomized clinical trial. JAMA 2021; 326 (05) 401-410
    CrossrefPubMedSuche in Google Scholar
  • 14 Curley MAQ, Wypij D, Watson RS. et al; RESTORE Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators Network. Protocolized sedation vs usual care in pediatric patients mechanically ventilated for acute respiratory failure: a randomized clinical trial. JAMA 2015; 313 (04) 379-389
    CrossrefPubMedSuche in Google Scholar
  • 15 Wieczorek B, Ascenzi J, Kim Y. et al. PICU Up!: impact of a quality improvement intervention to promote early mobilization in critically ill children. Pediatr Crit Care Med 2016; 17 (12) e559-e566
    CrossrefPubMedSuche in Google Scholar
  • 16 Fitzgerald RK, Davis AT, Hanson SJ. National Association of Children's Hospitals and Related Institution PICU Focus Group Investigators. Multicenter analysis of the factors associated with unplanned extubation in the PICU. Pediatr Crit Care Med 2015; 16 (07) e217-e223
    CrossrefPubMedSuche in Google Scholar
  • 17 Lucas da Silva PS, Fonseca MCM. Incidence and risk factors for cardiovascular collapse after unplanned extubations in the pediatric ICU. Respir Care 2017; 62 (07) 896-903
    CrossrefPubMedSuche in Google Scholar
  • 18 Klugman D, Berger JT, Spaeder MC, Wright A, Pastor W, Stockwell DC. Acute harm: unplanned extubations and cardiopulmonary resuscitation in children and neonates. Intensive Care Med 2013; 39 (07) 1333-1334
    CrossrefPubMedSuche in Google Scholar
  • 19 Li S, Rehder KJ, Giuliano Jr JS. et al; National Emergency Airway Registry for Children (NEAR4KIDS) Investigators, Pediatric Acute Lung Injury and Sepsis Investigator PALISI Network Investigators. Development of a quality improvement bundle to reduce tracheal intubation-associated events in pediatric ICUs. Am J Med Qual 2016; 31 (01) 47-55
    CrossrefPubMedSuche in Google Scholar
  • 20 Grunwell JR, Kamat PP, Miksa M. et al; National Emergency Airway Registry for Children (NEAR4KIDS) and the Pediatric Acute Lung Injury and Sepsis (PALISI) Network. Trend and outcomes of video laryngoscope use across PICUs. Pediatr Crit Care Med 2017; 18 (08) 741-749
    CrossrefPubMedSuche in Google Scholar
  • 21 Lucas da Silva PS, de Carvalho WB. Unplanned extubation in pediatric critically ill patients: a systematic review and best practice recommendations. Pediatr Crit Care Med 2010; 11 (02) 287-294
    CrossrefPubMedSuche in Google Scholar