Impact of Failure of Noninvasive Ventilation on the Safety of Pediatric Tracheal Intubation.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
pubmed:
24
7
2020
medline:
26
5
2021
entrez:
24
7
2020
Statut:
ppublish
Résumé
Noninvasive ventilation is widely used to avoid tracheal intubation in critically ill children. The objective of this study was to assess whether noninvasive ventilation failure was associated with severe tracheal intubation-associated events and severe oxygen desaturation during tracheal intubation. Prospective multicenter cohort study of consecutive intubated patients using the National Emergency Airway Registry for Children registry. Thirteen PICUs (in 12 institutions) in the United States and Canada. All patients undergoing tracheal intubation in participating sites were included. Noninvasive ventilation failure group included children with any use of high-flow nasal cannula, continuous positive airway pressure, or bilevel noninvasive ventilation in the 6 hours prior to tracheal intubation. Primary tracheal intubation group included children without exposure to noninvasive ventilation within 6 hours before tracheal intubation. None. Severe tracheal intubation-associated events (cardiac arrest, esophageal intubation with delayed recognition, emesis with aspiration, hypotension requiring intervention, laryngospasm, pneumothorax, pneumomediastinum) and severe oxygen desaturation (< 70%) were recorded prospectively. The study included 956 tracheal intubation encounters; 424 tracheal intubations (44%) occurred after noninvasive ventilation failure, with a median of 13 hours (interquartile range, 4-38 hr) of noninvasive ventilation. Noninvasive ventilation failure group included more infants (47% vs 33%; p < 0.001) and patients with a respiratory diagnosis (56% vs 30%; p < 0.001). Noninvasive ventilation failure was not associated with severe tracheal intubation-associated events (5% vs 5% without noninvasive ventilation; p = 0.96) but was associated with severe desaturation (15% vs 9% without noninvasive ventilation; p = 0.005). After controlling for baseline differences, noninvasive ventilation failure was not independently associated with severe tracheal intubation-associated events (p = 0.35) or severe desaturation (p = 0.08). In the noninvasive ventilation failure group, higher FIO2 before tracheal intubation (≥ 70%) was associated with severe tracheal intubation-associated events. Critically ill children are frequently exposed to noninvasive ventilation before intubation. Noninvasive ventilation failure was not independently associated with severe tracheal intubation-associated events or severe oxygen desaturation compared to primary tracheal intubation.
Identifiants
pubmed: 32701551
doi: 10.1097/CCM.0000000000004500
pii: 00003246-202010000-00013
doi:
Substances chimiques
Oxygen
S88TT14065
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1503-1512Subventions
Organisme : AHRQ HHS
ID : R03 HS021583
Pays : United States
Organisme : AHRQ HHS
ID : R18 HS022464
Pays : United States
Organisme : AHRQ HHS
ID : R18 HS024511
Pays : United States
Organisme : NHLBI NIH HHS
ID : UG3 HL141736
Pays : United States
Organisme : NHLBI NIH HHS
ID : U24 HL141723
Pays : United States
Organisme : NICHD NIH HHS
ID : R21 HD089151
Pays : United States
Commentaires et corrections
Type : CommentIn
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