Evaluating safety and quality of tracheal intubation in pediatric ICUs

描述（由申请人提供）：气管插管（TI）是儿科ICU中治疗的危重儿童的常见救生手术，但与频繁的并发症和不良安全性结局相关。由于低氧储备、不稳定的血流动力学和气道解剖结构，危重儿童的TI具有挑战性。尽管TI在儿科ICU中存在这些安全风险和独特挑战，但尚无可靠的前瞻性多中心数据来描述我们当前的实践并确定质量改进的机会。我们从单个儿科ICU记录的TI中前瞻性收集的初步数据是常见的（在45张床的ICU中每2.5天发生一次），并且不希望的TI相关事件（不良安全性结局）发生率>20%。然而，这些发现不能简单地概括，因为TI和不必要的TI相关事件的发生率高度依赖于患者，提供者和实践特征。因此，至关重要的是开发和实施一个前瞻性数据库，以获取不同儿科ICU的当前实践，具有统一的操作定义和接近100%的数据合规性，无报告偏倚。该项目将扩展我们的单中心儿科TI登记：国家儿童紧急气道登记（NEAR4KID）到PALISI参与的儿科ICU的不同范围（大到小，学术到私人）。我们将通过以下策略推进和扩大注册表：1.实施高度合规的数据采集和交叉检查系统2.使用前瞻性定义的共识操作定义3.验证和交叉检查数据4.开发标准共识报告系统，以记录影响患者安全的过程差异和结果。在完成该试点项目后，我们将使用前瞻性多中心数据来描述当前实践的特征，并在儿科ICU的多样化网络中确定质量改进和研究的循证机会。我们将确定未来干预性研究的关键候选变量，以提高患者的安全性。该拟议的RO3项目是从我们的单中心TI安全性经验到多中心临床试验的重要桥梁， 美国和世界各地重症儿童的结局。 公共卫生相关性：在儿科重症监护病房（PICU）中，通过在气道中放置导管以支持呼吸来抢救呼吸衰竭的危重患儿是一种常见的高风险手术，通常会导致并发症。我们的研究网络由15个不同的PICU组成，将描述当前实践的景观以及与风险和并发症相关的因素，作为未来的质量改进目标。这是至关重要的下一步，以提高安全性和结果的儿童谁需要呼吸支持在广泛的PICU。

DESCRIPTION (provided by applicant): Tracheal intubation (TI) is a common, life-saving procedure for critically ill children treated in Pediatric ICUs, but associated with frequent complications and adverse safety outcomes. TI in critically ill children is challenging because of low oxygen reserve, unstable hemodynamics, and airway anatomy. Despite these safety risks and unique challenges for TI in pediatric ICUs, reliable prospective multi-center data to characterize our current practice and identify opportunities for quality improvement is not available. Our preliminary prospectively-collected data from a single pediatric ICU documented TIs are common (one in every 2.5 days in 45 beds ICU) and unwanted TI associated events (adverse safety outcomes) occur in >20% . However, these findings cannot be simply generalized because the incidence of TIs and unwanted TI associated events are highly dependent on patient, provider and practice characteristics. Thus, it is critically important to develop and implement a prospective database to capture the current practice across diverse pediatric ICUs with uniform operational definitions and near 100% data compliance without reporting bias. This project will expand our single-center pediatric TI registry: National Emergency Airway Registry for Children (NEAR4KIDs) to a diverse spectrum (large to small, academic to private) of PALISI participating pediatric ICUs. We will advance and expand the registry with the following strategies: 1. Implement high compliance data capture and crosscheck system 2. Use prospectively defined consensus operational definitions 3. Verify and crosscheck the data 4. Develop a standard consensus reporting system to document the process variances and outcomes that impact patient safety. Upon completion of this pilot project, we will have used prospective multi-center data to characterize the current practice and identify evidence-based opportunities for quality improvement and research across a diverse network of pediatric ICUs. We will identify key candidate variables for future interventional studies that could improve patient safety. This proposed RO3 project is an essential bridge from our single center TI safety experience to multi-center clinical trials that will ultimately improve the outcome of critically ill children across the US and the world. PUBLIC HEALTH RELEVANCE: Rescuing critically ill children from respiratory failure by placing a tube in the airway to support breathing is a common, high risk procedure in pediatric intensive care units (PICUs) that often results in complications. Our research network of 15 diverse PICUs will characterize the landscape of current practice and factors associated with risks and complications as future quality improvement targets. This is the critically important next step to improve safety and outcomes of children who need respiratory support across broad spectrum of PICUs.