Evaluating safety and quality of tracheal intubation in pediatric ICUs

描述(由申请人提供)：气管插管(TI)是在儿科ICU治疗的危重儿童的一种常见的挽救生命的程序，但与频繁的并发症和不良的安全后果相关。由于低氧储备、血流动力学不稳定和呼吸道解剖，危重儿童的经皮冠状动脉介入治疗具有挑战性。尽管TI在儿科ICU中面临这些安全风险和独特的挑战，但无法获得可靠的前瞻性多中心数据来表征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TIS中收集的初步数据很常见(在45个床位的ICU中每2.5天就有一例)，不希望发生的TI相关事件(不良安全结果)发生在&gt；20%。然而，这些发现不能简单地概括，因为TIS和不想要的TI相关事件的发生率高度依赖于患者、提供者和从业人员的特征。因此，重要的是开发和实施一个前瞻性的数据库，以获取不同儿科ICU的当前实践，具有统一的操作定义和几乎100%的数据遵从性，而不存在报告偏差。该项目将扩大我们的单中心儿科TI登记：国家儿童急救呼吸道登记(NEAR4KID)，以不同的范围(从大到小，从学术到私人)参加帕里西参与的儿科ICU。我们将通过以下策略推进和扩大注册：1.实施高遵从性数据捕获和交叉检查系统2.使用预期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。在这个试点项目完成后，我们将使用预期的多中心数据来描述当前的实践，并确定在不同的儿科ICU网络中进行质量改进和研究的循证机会。我们将为未来可能提高患者安全性的介入研究确定关键的候选变量。建议的R03项目是从我们的单中心TI安全体验到最终将改善的多中心临床试验的重要桥梁 美国和世界各地危重儿童的结局。 公共卫生相关性：在儿科重症监护病房(PICU)中，通过在呼吸道内放置管子来支持呼吸是一种常见的、高风险的操作，通常会导致并发症。我们由15个不同的PICU组成的研究网络将表征当前实践的格局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，以改善需要广泛PICU呼吸支持的儿童的安全性和预后。

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.