The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study.
The number of tracheal intubation attempts matters! A prospective multi-institutional pediatric observational study.
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DOI：
10.1186/s12887-016-0593-y
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发表时间：
2016-04-29
期刊：
影响因子：
2.4
通讯作者：
National Emergency Airway Registry for Children (NEAR4KIDS)
中科院分区：
文献类型：
--
作者：
Lee JH;Turner DA;Kamat P;Nett S;Shults J;Nadkarni VM;Nishisaki A;Pediatric Acute Lung Injury and Sepsis Investigators (PALISI);National Emergency Airway Registry for Children (NEAR4KIDS)
多次气管插管(TI)尝试对重症急性呼吸衰竭患儿预后的影响尚不清楚。我们研究的目的是确定TI尝试次数与严重的血氧饱和度降低(SpO2 <； 70%)和不良TI相关事件(TIAE)之间的关系。我们对一个前瞻性的多中心TI数据库(国家儿童急诊呼吸道登记处：NEAR4KIDS)进行了分析。主要暴露变量是分为一次、两次或≥3次的TI尝试次数。对困难的呼吸道病史、上呼吸道阻塞和年龄进行了估计。我们纳入了2010年7月3日至2013年3月3日期间所有因急性呼吸衰竭而行直接喉镜检查的首次感染儿童。我们的主要结果是降低饱和度(在介入治疗期间为80%)、严重降低(70%)、不良和严重的TIAE(例如，心脏骤停、低血压需要治疗)。在3382例TIS中，2080例(65%)为急性呼吸衰竭。第一次尝试成功1256/2080年(60%)，第二次尝试503/2080年(24%)，≥3次尝试321/2080年(15%)。较高的尝试次数与较年轻的年龄、困难的呼吸道病史、上呼吸道阻塞的迹象以及第一提供者的培训水平有关。不饱和TIS的比例随着尝试次数的增加而增加(1次尝试：16%，2次尝试：36%，≥3次尝试：56%，p <； 0.001；2次尝试的调整OR：2.9[95%CI：2.3-3.7]；≥3次尝试：6.5[95%CI：5.0-8.5]，根据患者因素进行调整)。严重不饱和TIS的比例也随着尝试次数的增加而增加(1次尝试：12%，2次尝试：30次，≥3次尝试：44次，p <； 0.001)；2次尝试的调整OR：3.1[95%CI：2.4-4.0]；≥3次尝试：5.7[95%CI：4.3-7.5])。随着尝试次数的增加，TIAE发生率从10%到29%上升到38%(p <； 0.001)；2次尝试的调整OR：3.7[95%CI：2.9-4.9]；≥3次尝试：5.5[95%CI：4.1-7.4]。严重TIAE发生率从5%到8%到9%(p = 0.008)；2次尝试的调整OR：1.6[95%CI：1.1-2.4]；≥3次尝试：1.8[95%CI：1.1-2.8]。在患有急性呼吸衰竭的危重儿童中，TI尝试的次数与去饱和度和TIAE的发生率增加有关。深思熟虑地关注最初的提供者以及最佳的设置/准备对于最大限度地增加首次尝试成功的机会和避免降低饱和度是重要的。本文的在线版本(doi：10.1186/s12887-0160593-y)包含补充材料，授权用户可以使用。
The impact of multiple tracheal intubation (TI) attempts on outcomes in critically ill children with acute respiratory failure is not known. The objective of our study is to determine the association between number of TI attempts and severe desaturation (SpO2 < 70 %) and adverse TI associated events (TIAEs). We performed an analysis of a prospective multicenter TI database (National Emergency Airway Registry for Children: NEAR4KIDS). Primary exposure variable was number of TI attempts trichotomized as one, two, or ≥3 attempts. Estimates were adjusted for history of difficult airway, upper airway obstruction, and age. We included all children with initial TI performed with direct laryngoscopy for acute respiratory failure between 7/2010-3/2013. Our main outcome measures were desaturation (<80 % during TI attempt), severe desaturation (<70 %), adverse and severe TIAEs (e.g., cardiac arrest, hypotension requiring treatment). Of 3382 TIs, 2080(65 %) were for acute respiratory failure. First attempt success was achieved in 1256/2080(60 %), second attempt in 503/2080(24 %), and ≥3 attempts in 321/2080(15 %). Higher number of attempts was associated with younger age, history of difficult airway, signs of upper airway obstruction, and first provider training level. The proportion of TIs with desaturation increased with increasing number of attempts (1 attempt:16 %, 2 attempts:36 %, ≥3 attempts:56 %, p < 0.001; adjusted OR for 2 attempts: 2.9[95 % CI:2.3–3.7]; ≥3 attempts: 6.5[95 % CI: 5.0–8.5], adjusted for patient factors). Proportion of TIs with severe desaturation also increased with increasing number of attempts (1 attempt:12 %, 2 attempts:30 %, ≥3 attempts:44 %, p < 0.001); adjusted OR for 2 attempts: 3.1[95 % CI:2.4–4.0]; ≥3 attempts: 5.7[95 % CI: 4.3–7.5] ). TIAE rates increased from 10 to 29 to 38 % with increasing number of attempts (p < 0.001); adjusted OR for 2 attempts: 3.7[95 % CI:2.9–4.9] ; ≥3 attempts: 5.5[95 % CI: 4.1–7.4]. Severe TIAE rates went from 5 to 8 to 9 % (p = 0.008); adjusted OR for 2 attempts: 1.6 [95 % CI:1.1–2.4]; ≥3 attempts: 1.8[95 % CI:1.1–2.8]. Number of TI attempts was associated with desaturations and increased occurrence of TIAEs in critically ill children with acute respiratory failure. Thoughtful attention to initial provider as well as optimal setting/preparation is important to maximize the chance for first attempt success and to avoid desaturation. The online version of this article (doi:10.1186/s12887-016-0593-y) contains supplementary material, which is available to authorized users.