Key result
Pediatric cardiac ICUs did not significantly reduce adverse tracheal intubation-associated events vs noncardiac PICUs in children with cardiac disease (16% vs 19%; aOR 0.74, 95% CI 0.54-1.02; P=0.069).
Why the study?
Differences in tracheal intubation-associated events and process variances between pediatric cardiac ICUs and noncardiac PICUs in children with underlying cardiac disease required evaluation.
Does tracheal intubation in a pediatric cardiac ICU reduce adverse intubation-associated events compared to noncardiac PICUs in children with underlying cardiac disease?
Cohort (n=1,502)
Yes
Does tracheal intubation in a pediatric cardiac ICU reduce adverse intubation-associated events compared to noncardiac PICUs in children with underlying cardiac disease?
In children with cardiac disease, intubation in a dedicated cardiac ICU was not associated with a significantly lower rate of adverse intubation-associated events compared to noncardiac ICUs.
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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Gradidge et al. (2017) conducted a cohort in Medical or surgical cardiac disease requiring tracheal intubation (n=1,502). Pediatric cardiac ICU location vs. Noncardiac PICU location was evaluated on Rate of any adverse tracheal intubation-associated event (OR 0.74, 95% CI 0.54-1.02, p=0.069). Pediatric cardiac ICUs did not significantly reduce adverse tracheal intubation-associated events vs noncardiac PICUs in children with cardiac disease (16% vs 19%; aOR 0.74, 95% CI 0.54-1.02; P=0.069).
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