Effect of Location on Tracheal Intubation Safety in Cardiac Disease-Are Cardiac ICUs Safer?
Effect of Location on Tracheal Intubation Safety in Cardiac Disease-Are Cardiac ICUs Safer?
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位置对心脏病气管插管安全性的影响——心脏 ICU 更安全吗？
DOI：
10.1097/pcc.0000000000001422
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Cheifitz
中科院分区：
文献类型：
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作者：
Gradidge,EleanorA;Bakar,Adnan;Tellez,David;Ruppe,Michael;Tallent,Sarah;Bird,Geoffrey;Lavin,Natasha;Lee,Anthony;Adu-Darko,Michelle;Bain,Jesse;Biagas,Katherine;Branca,Aline;Breuer,RyanK;Brown3rd,Calvin;Bysani,GKris;Cheifitz
目的：评价在患有基础心脏病的儿童中，儿科心脏ICU和非心脏PICU之间气管插管相关事件和过程差异（即多次插管尝试和氧饱和度下降）的差异。设计：使用多中心气管插管质量改善数据库（国家儿童紧急气道登记处）的回顾性队列研究。设置：2012年7月至2016年3月，36个PICU（5个心脏ICU，31个非心脏ICU）。患者：患有内科或外科心脏病并在ICU接受插管的儿童。干预措施：无。测量和主要结果：我们的主要结局是任何不良气管插管相关事件的发生率。次要结局为严重气管插管相关事件、多次气管插管尝试率和氧饱和度下降。报告了1，502例基础心脏病儿童气管插管（751例在心脏ICU，751例在非心脏ICU）。心脏ICU和非心脏ICU的外科心脏病患者比例相似。在心脏ICU接受插管的患者比非心脏ICU（中位数3个月[四分位距，1-11个月]; p< 0.001）年轻（中位数1个月[四分位距，0-6个月]）。心源性ICU和非心源性ICU的气管插管相关事件发生率无差异（16% vs 19%;校正比值比，0.74; 95% CI，0.54-1.02; p= 0.069）。然而，在一项比较心脏ICU与混合ICU（即，照顾患有一般儿科或心脏疾病的儿童的ICU）的敏感性分析中，心脏ICU的不良事件几率降低（调整后的比值比，0.71; 95% CI，0.52-0.97; p= 0.033）。严重气管插管相关事件和多次尝试的发生率相似。在心脏ICU插管期间更常发生去饱和（调整后的比值比，1.61; 95%CI，1.04-1.15; p= 0.002）。结论：在患有基础心脏疾病的儿童中，与非心脏ICU相比，心脏ICU的不良气管插管相关事件发生率并不低，即使在调整了患者特征和护理模式的差异后。
Objectives:Evaluate differences in tracheal intubation–associated events and process variances (ie, 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 (ie, 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.