Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-25T02:07:58.168Z Has data issue: false hasContentIssue false
  • English
  • Français

Safety of tracheal intubation in the presence of cardiac disease in paediatric ICUs

Published online by Cambridge University Press:  25 April 2018

Eleanor A. Gradidge Open the ORCID record for Eleanor A. Gradidge [Opens in a new window] ,
Adnan Bakar ,
David Tellez ,
Michael Ruppe ,
Sarah Tallent ,
Geoffrey Bird ,
Natasha Lavin ,
Anthony Lee ,
Vinay Nadkarni  and
Michelle Adu-Darko
...Show all authors
Eleanor A. Gradidge*
Affiliation:
Division of Pediatric Critical Care, Phoenix Children’s Hospital, Phoenix, AZ, USA
Adnan Bakar
Affiliation:
Pediatric Cardiology, Cohen Children’s Medical Center, Northwell Health System, Hofstra School of Medicine, New Hyde Park, NY, USA
David Tellez
Affiliation:
Division of Pediatric Critical Care, Phoenix Children’s Hospital, Phoenix, AZ, USA
Michael Ruppe
Affiliation:
Department of Pediatrics, Division of Critical Care Medicine, University of Louisville School of Medicine, Norton Children’s Hospital, Louisville, KY, USA
Sarah Tallent
Affiliation:
Division of Pediatric Critical Care Medicine, Duke University Hospital, Durham, NC, USA
Geoffrey Bird
Affiliation:
Division of Cardiac Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Natasha Lavin
Affiliation:
Respiratory Care Department, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Anthony Lee
Affiliation:
Department of Pediatrics, Ohio State University College of Medicine, Nationwide Children’s Hospital, Columbus, OH, USA
Vinay Nadkarni
Affiliation:
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Michelle Adu-Darko
Affiliation:
Department of Pediatrics, Division of Pediatric Critical Care, University of Virginia Children’s Hospital, Charlottesville, VA, USA
Jesse Bain
Affiliation:
Department of Pediatrics, Division of Critical Care Medicine, Children’s Hospital of Richmond at VCU, Richmond, VA, USA
Katherine Biagas
Affiliation:
Division of Pediatric Critical Care Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
Aline Branca
Affiliation:
Division of Pediatric Critical Care, Phoenix Children’s Hospital, Phoenix, AZ, USA
Ryan K. Breuer
Affiliation:
Division of Critical Care, UBMD Pediatrics, Women and Children’s Hospital of Buffalo, University at Buffalo, Buffalo, NY, USA
Calvin Brown III
Affiliation:
Department of Emergency Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
Kris Bysani
Affiliation:
Pediatric Acute Care Associates of North Texas PLLC, Medical City Children’s Hospital, Dallas, TX, USA
Guillaume Emeriaud
Affiliation:
Department of Pediatrics, CHU Sainte Justine, Université de Montréal, Montreal, QC, Canada
Sandeep Gangadharan
Affiliation:
Pediatric Cardiology, Cohen Children’s Medical Center, Northwell Health System, Hofstra School of Medicine, New Hyde Park, NY, USA
John S. Giuliano Jr
Affiliation:
Department of Pediatrics, Division of Critical Care Medicine, Yale University School of Medicine, New Haven, CT, USA
Joy D. Howell
Affiliation:
Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
Conrad Krawiec
Affiliation:
Division of Pediatrics Critical Care Medicine, Department of Pediatrics and Public Health Science, Penn State Hershey Children’s Hospital, Hershey, PA, USA
Jan Hau Lee
Affiliation:
KK Women’s and Children’s Hospital, Singapore, Singapore
Simon Li
Affiliation:
Department of Pediatrics, Division of Critical Care Medicine, New York Medical College, Maria Fareri Children’s Hospital, Valhalla, NY, USA
Keith Meyer
Affiliation:
Nicklaus Children’s Hospital, Miami Children’s Health System, Miami, FL, USA
Michael Miksa
Affiliation:
Department of Pediatric Critical Care, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
Natalie Napolitano
Affiliation:
Respiratory Care Department, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
Sholeen Nett
Affiliation:
Department of Pediatrics, Section of Pediatric Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
Gabrielle Nuthall
Affiliation:
Paediatric Intensive Care Unit, Starship Children’s Hospital, Auckland, New Zealand
Alberto Orioles
Affiliation:
Children’s Respiratory and Critical Care Specialist, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
Erin B. Owen
Affiliation:
Department of Pediatrics, Division of Critical Care Medicine, University of Louisville School of Medicine, Norton Children’s Hospital, Louisville, KY, USA
Margaret M. Parker
Affiliation:
Department of Pediatrics, Stony Brook Children’s Hospital, Stony Brook, NY, USA
Simon Parsons
Affiliation:
Department of Critical Care, Alberta Children’s Hospital, Calgary, AB, Canada
Lee A. Polikoff
Affiliation:
Division of Pediatric Critical Care Medicine, The Warren Alpert School of Medicine at Brown University, Providence, RI, USA
Kyle Rehder
Affiliation:
Division of Pediatric Critical Care Medicine, Duke University Hospital, Durham, NC, USA
Osamu Saito
Affiliation:
Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
Ron C. Sanders Jr
Affiliation:
Section of Pediatric Critical Care, Department of Pediatrics, University of Arkansas College of Medicine, Little Rock, AR, USA
Asha Shenoi
Affiliation:
Department of Pediatrics, Division of Pediatric Critical Care, Kentucky Children’s Hospital, University of Kentucky College of Medicine, Lexington, KY, USA
Dennis W. Simon
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Peter W. Skippen
Affiliation:
Pediatric Intensive Care Unit, BC Children’s Hospital, Vancouver, BC, Canada
Keiko Tarquinio
Affiliation:
Department of Pediatrics, Division of Pediatric Critical Care Medicine, Emory University School of Medicine, Atlanta, GA, USA
Anne Thompson
Affiliation:
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Iris Toedt-Pingel
Affiliation:
Pediatric Critical Care, University of Vermont College of Medicine, Burlington, VT, USA
Karen Walson
Affiliation:
Department of Critical Care, Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA
Akira Nishisaki
Affiliation:
Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
*
Author for correspondence: E. A. Gradidge, MD, Department of Pediatrics, Division of Pediatric Critical Care, Ochsner Hospital for Children, 1514 Jefferson Highway, New Orleans, LA 70121, USA. Tel: 504 842 3000; Fax: 504 842 6713; E-mail: gradidge.eleanor@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.

Materials and methods

We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.

Results

A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.

Conclusions

The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.

Keywords

Tracheal intubationsafetyquality improvementpaediatric ICUcardiac diseasecardiac arrest
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 7 , July 2018 , pp. 928 - 937
Check for updates
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Murphy, TWG, Smith, JH, Ranger, MRB, Haynes, SR. General anesthesia for children with severe heart failure. Pediatr Cardiol 2011; 32: 139–144.Google Scholar
2. Saiki, H, Sugimoto, M, Kuwata, S, et al. Novel mechanisms for cerebral blood flow regulation in patients with congenital heart disease. Am Heart J 2016; 172: 152–159.Google Scholar
3. Nishisaki, A, Turner, SA, Brown, CA 3rd, et al. A National Emergency Airway Registry for children: landscape of tracheal intubation in 15 PICUs. Crit Care Med 2013; 41: 874–885.Google Scholar
4. Guillemaud, JP, El-Hakim, H, Richards, S, Chauhan, N. Airway pathologic abnormalities in symptomatic children with congenital cardiac and vascular disease. Arch Otolaryngol Head Neck Surg 2007; 133: 672–676.CrossRefGoogle ScholarPubMed
5. Lee, AL, Cheung, YF, Leung, MP, Ng, YK, Tsoi, NS. Airway obstruction in children with congenital heart disease: Assessment by flexible bronchoscopy. Pediatr Pulmonol 2002; 34: 304–311.Google Scholar
6. Wang, C-C, Chen, S-J, Wu, E-T, et al. Lower airway anomalies in children with CATCH 22 syndrome and congenital heart disease. Pediatr Pulmonol 2013; 48: 587–591.Google Scholar
7. Sanders, RC Jr, Giuliano, JS Jr, Sullivan, JE, et al. Level of trainee and tracheal intubation outcomes. Pediatrics 2013; 131: e821–e828.Google Scholar
8. Graciano, AL, Tamburro, R, Thompson, AE, Fiadjoe, J, Nadkarni, VM, Nishisaki, A. Incidence and associated factors of difficult tracheal intubations in pediatric ICUs: a report from National Emergency Airway Registry for Children: NEAR4KIDS. Intensive Care Med 2014; 40: 1659–1669.Google Scholar
9. Tarquino, KM, Howell, JD, Montgomery, V, et al. Current medication practice and tracheal intubation safety outcomes from a prospective multicenter observational cohort study. Pediatr Crit Care Med 2015; 16: 210–218.CrossRefGoogle Scholar
10. Hickey, PR, Hansen, DD, Wessel, DL, Lang, P, Jonas, RA. Pulmonary and systemic hemodynamic responses to fentanyl in infants. Anesth Analg 1985; 64: 483–486.Google Scholar
11. Cordina, RL, Celermajer, DS. Chronic cyanosis and vascular function: implications for patients with cyanotic congenital heart disease. Cardiol Young 2010; 20: 242–253.Google Scholar
12. Kipps, AK, Ramamoorthy, C, Rosenthal, DN, Williams, GD. Children with cardiomyopathy: complications after noncardiac procedures with general anesthesia. Paediatr Anaesth 2007; 17: 775–781.CrossRefGoogle ScholarPubMed
13. Lee, Y-S, Jeng, M-J, Tsao, P-C, Soong, W-J, Chou, P. Prognosis and risk factors for congenital airway anomalies in children with congenital heart disease: a nationwide population-based study in Taiwan. PLoS One 2015; 10: e0137437.CrossRefGoogle ScholarPubMed
14. Anderson, LW, Vognsen, M, Topjian, A, et al. Pediatric in-hospital acute respiratory compromise: a report from the American Heart Association’s Get with the Guidelines Resuscitation Registry. Pediatr Crit Care Med 2017; 18: 838–849.Google Scholar
15. Bronicki, RA, Penny, DJ, Anas, NG, Fuhrman, B. Cardiopulmonary interactions. Pediatr Crit Care Med 2016; 17: S182–S193.Google Scholar
16. Marik, PE, Cavallazzi, R, Vasu, T, Hirani, A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med 2009; 37: 2642–2647.CrossRefGoogle ScholarPubMed
17. Monnet, X, Teboul, JL, Richard, C. Cardiopulmonary interactions in patients with heart failure. Curr Opin Crit Care 2007; 13: 6–11.CrossRefGoogle ScholarPubMed
18. Zgleszewski, SE, Graham, DA, Hickey, PR, et al. Anesthesiologist- and systems-related risk factors for risk-adjusted pediatric anesthesia-related cardiac arrest. Anesth Analog 2016; 122: 482–489.CrossRefGoogle Scholar
19. Morris, MC, Wernovsky, G, Nadkarni, VM. Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 2004; 5: 440–446.CrossRefGoogle ScholarPubMed
20. Pfammatter, J-P, Casualta, C, Pavlovic, M, Berdat, PA, Frey, U, Carrel, T. Important excess morbidity due to upper airway anomalies in the perioperative course in infant cardiac surgery. Ann Thorac Surg 2006; 81: 1008–1012.Google Scholar
21. Gradidge, EA, Bakar, A, Tellez, D, et al. Effect of location on tracheal intubation safety in cardiac disease – are cardiac ICUs safer? Pediatr Crit Care Med 2018; 19: 218–227.Google Scholar
22. Czaja, AS, Scanlon, MC, Kuhn, EM, Jeffries, HE. Performance of the pediatric index of mortality 2 for pediatric cardiac surgery patients. Pediatr Crit Care Med 2011; 12: 184–189.Google Scholar
23. Slater, A, Shann, F, , Pearson G for the PIM2 Study Group. PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 2003; 29: 278–285.Google Scholar
24. Jenkins, KJ, Gauvreau, K, Newburger, JW, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118.CrossRefGoogle ScholarPubMed
25. Parker, M, Nuthall, G, Brown, C III, et al. Relationship between adverse tracheal intubation associated events and pediatric ICU outcomes. Pediatr Crit Care Med 2017; 18: 310–318.CrossRefGoogle Scholar