Research Activities, September 2013
Expanded National Emergency Airway Registry for Children has the potential to improve safety in pediatric intensive care units
The National Emergency Airway Registry for Children (NEAR4KIDS), which captures information about the process of airway management in critically ill children in pediatric intensive care units (PICUs), may help improve the safety of this procedure, a new study suggests.
Tracheal intubation, the most common practice in airway management, is performed in critically ill children for a wide variety of problems. However, safety-associated factors have previously been studied only in single PICUs. The current registry that looked at 15 PICUs found that adverse tracheal intubation-associated events (TIAEs) were common, occurring in 20 percent of intubation attempts in one study and over 40 percent in another. NEAR4KIDS was developed to collect and compare information on tracheal intubation process and care from many diverse PICUs.
The registry began with 15 academic PICUs in North America that submitted data on 1,715 patients who underwent initial—and, in some cases, second or third attempts—of tracheal intubation. The researchers found that registry patients (median age of 1 year) underwent intubation for a respiratory diagnosis in 45 percent of cases and because of respiratory failure associated with other diagnoses (such as cardiac problems, sepsis or shock, neurological problems, or trauma) in 34 percent.
Tracheal intubation was successful in 98 percent of cases—62 percent of first attempts, with 14 percent of the patients requiring three or more attempts for success (1,821 total attempts). Among all of the attempts, 20 percent were associated with at least one TIAE, with the event rate per PICU ranging from 0–41 percent of intubation. Severe TIAEs were reported in 6 percent of attempts, with severe event rates ranging from 0-20 percent of attempts per PICU.
The most common of the 284 non-severe events (16 percent of attempts) were 167 instances (9 percent) of intubating the esophagus rather than the trachea, with immediate recognition of the problem. Despite the small number of PICUs involved, the researchers demonstrated the magnitude of the current gap in practice and identified some potential risk factors for TIAEs. The researchers recruited the 15 participating PICUs from members of the Pediatric Acute Lung Injury and Sepsis Investigators, and analyzed data on all tracheal intubations performed between July 2010 and December 2011. The study was funded in part by AHRQ (HS21583).
More details are in "A National Emergency Airway Registry for Children: Landscape of tracheal intubation in 15 PICUs," by Akira Nishisaki, M.D., M.S.C.E., David A. Turner, M.D., Calvin A. Brown III, M.D., and others in the March 2013 Critical Care Medicine 41(3), pp. 874-885.