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Incidence and associated factors of difficult tracheal intubations in pediatric ICUs: a report from National Emergency Airway Registry for Children: NEAR4KIDS

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Abstract

Purpose

To evaluate the incidence and associated risk factors of difficult tracheal intubations (TI) in pediatric intensive care units (PICUs).

Methods

Using the National Emergency Airway Registry for Children (NEAR4KIDS), TI quality improvement data were prospectively collected for initial TIs in 15 PICUs from July 2010 to December 2011. Difficult pediatric TI was defined as TIs by direct laryngoscopy which failed or required more than two laryngoscopy attempts by fellow/attending-level physician providers.

Results

A total of 1,516 oral TIs were reported with a median age of 2 years. A total of 97 % of patients were intubated with direct laryngoscopy. The incidence of difficult TI was 9 %. In univariate analysis, patients with difficult TI were younger [median 1 year (0–4) vs. 2 (0–8) years, p = 0.046], and had a reported history of difficult TI (22 vs. 8 %, p < 0.001). Multivariate analysis showed that history of difficult airway and signs of upper airway obstruction are significantly associated with difficult TI. The advanced airway provider was more involved as a first provider in difficult TI (81 vs. 58 %, p < 0.001). The presence of difficult TI was associated with higher incidence of oxygen desaturation below 80 % (48 vs. 15 %, p < 0.001), adverse TI associated events (53 vs. 20 %, p < 0.001), and severe TI associated events (13 vs. 6 %, p = 0.003).

Conclusions

Difficult TI was reported in 9 % of all TIs and was associated with increased adverse TI events. History of difficult airway and sign of upper airway obstruction were associated with difficult TIs.

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Acknowledgments

We acknowledge Jessica Leffelman for her tireless work as a multicenter coordinator. We also acknowledge Stephanie Tuttle, MBA for her administrative support. We thank Dr. Shults (University of Pennsylvania) for providing guidance for statistical analysis. Endowed Chair, Critical Care Medicine, The Children’s Hospital of Philadelphia; Unrestricted funds from the Laerdal Foundation Acute Care Medicine; Agency for Healthcare Research and Quality grant: 1R03HS021583-01.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Critical Care Medicine, Children’s Hospital Central California, 6235 N Fresno St Ste 103 (OS43), Fresno, 93710, CA, USA

    Ana Lia Graciano

  2. Department of Pediatrics, Division of Critical Care Medicine, Penn State Hershey Children’s Hospital, Pennsylvania State University College of Medicine, 500 University Drive, MC HO85, Hershey, 17033, PA, USA

    Robert Tamburro

  3. Department of Anesthesia and Critical Care, University of Pittsburgh, Floor 5, 4401 Penn Avenue, Pittsburgh, 15224, PA, USA

    Ann E. Thompson

  4. Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd. CHOP 8NE Suite 8566, Philadelphia, PA, 19104, USA

    John Fiadjoe, Vinay M. Nadkarni & Akira Nishisaki

Authors
  1. Ana Lia Graciano
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  2. Robert Tamburro
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  3. Ann E. Thompson
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  4. John Fiadjoe
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  5. Vinay M. Nadkarni
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  6. Akira Nishisaki
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Corresponding author

Correspondence to Akira Nishisaki.

Additional information

For the National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.

Take-home message: Difficult tracheal intubation was reported in 9 % of all instances in a wide variety of pediatric ICUs in North America, associated with signs of upper airway obstruction and history of difficult airway. More adverse tracheal intubation-associated events and longer pediatric ICU admissions were seen in patients with difficult tracheal intubation.

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Graciano, A.L., Tamburro, R., Thompson, A.E. et al. Incidence and associated factors of difficult tracheal intubations in pediatric ICUs: a report from National Emergency Airway Registry for Children: NEAR4KIDS. Intensive Care Med 40, 1659–1669 (2014). https://doi.org/10.1007/s00134-014-3407-4

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  • DOI: https://doi.org/10.1007/s00134-014-3407-4

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