Characterization of tracheal intubation process of care and safety outcomes in a tertiary pediatric intensive care unit
Characterization of tracheal intubation process of care and safety outcomes in a tertiary pediatric intensive care unit
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DOI：
10.1097/pcc.0b013e3181fe472d
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发表时间：
2012-01-01
影响因子：
4.1
通讯作者：
Nadkarni, Vinay M.
中科院分区：
文献类型：
--
作者：
Nishisaki, Akira;Ferry, Susan;Nadkarni, Vinay M.
目的：使用国家紧急气道登记处的儿科改编，描述大型三级儿科重症监护病房中气管插管护理过程和安全性结局的特征。尚未描述儿科重症监护室插管的护理过程和安全性结局的差异。我们假设气管插管是一种常见但高风险的手术，并且国家紧急气道登记处的新儿科适应症是一种可行的工具，可以捕获护理过程和结果的差异。设计：前瞻性描述性研究。设置：一所大型大学附属儿童医院的一个45张床位的三级非心脏儿科重症监护室。患者：在儿科重症监护室需要插管的危重患儿。干预措施：前瞻性收集了2007年7月至2008年9月所有初始气道管理的气道管理数据，使用为儿科应用定制的国家紧急气道登记工具，定义测量和主要结果：报告了197例初次插管（平均每2.3天一次）。第一疗程插管方法为经口插管181例（91.9%），经鼻插管16例（9.1%）。经常报告意外气管插管相关事件（n = 38 [19.3%]），但重度气管插管相关事件罕见（n = 6 [3.0%]）。立即识别的食管插管是最常见的气管插管相关事件（n = 22）。去饱和
Objective: To characterize tracheal intubation process of care and safety outcomes in a large tertiary pediatric intensive care unit using a pediatric adaptation of the National Emergency Airway Registry. Variances in process of care and safety outcome of intubation in the pediatric intensive care unit have not been described. We hypothesize that tracheal intubation is a common but high-risk procedure and that the novel pediatric adaptation of the National Emergency Airway Registry is a feasible tool to capture variances in process of care and outcomes.Design: Prospective descriptive study.Setting: A single 45-bed tertiary noncardiac pediatric intensive care unit in a large university-affiliated children's hospital.Patients: Critically ill children who required intubation in the pediatric intensive care unit.Interventions: Airway management data were prospectively collected for all initial airway management from July 2007 through September 2008 using the National Emergency Airway Registry tool tailored for pediatric application with explicit operational definitions.Measurement and Main Results: One hundred ninety-seven initial intubation encounters were reported (averaging one every 2.3 days). The first course intubation method was oral intubation in 181 (91.9%) and nasal in 16 (9.1%). Unwanted tracheal intubation-associated events were frequently reported (n = 38 [19.3%]), but severe tracheal intubation-associated events were rare (n = 6 [3.0%]). Esophageal intubation with immediate recognition was the most common tracheal intubation-associated event (n = 22). Desaturation