Laurence Ducharme-Crevier, Jamie Furlong-Dillard, Philipp Jung, Fabrizio Chiusolo, Matthew P Malone, Shashikanth Ambati, Simon J Parsons, Conrad Krawiec, Awni Al-Subu, Lee A Polikoff, Natalie Napolitano, Keiko M Tarquinio, Asha Shenoi, Andrea Talukdar, Palen P Mallory, John S Giuliano, Ryan K Breuer, Krista Kierys, Serena P Kelly, Makoto Motomura, Ron C Sanders, Ashley Freeman, Yuki Nagai, Lily B Glater-Welt, Joseph Wilson, Mervin Loi, Michelle Adu-Darko, Justine Shults, Vinay Nadkarni, Guillaume Emeriaud, Akira Nishisaki
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As such, safety and descriptive data regarding this practice are warranted.</p><p><strong>Methods: </strong>We evaluated the association between TI route and safety outcomes in a prospectively collected quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from 2013 to 2020. The primary outcome was severe desaturation (SpO<sub>2</sub> > 20% from baseline) and/or severe adverse TI-associated events (TIAEs), using NEAR4KIDS definitions. To balance patient, provider, and practice covariates, we utilized propensity score (PS) matching to compare the outcomes of nasal vs. oral TI.</p><p><strong>Results: </strong>A total of 22,741 TIs [nasal 870 (3.8%), oral 21,871 (96.2%)] were reported from 60 PICUs. Infants were represented in higher proportion in the nasal TI than the oral TI (75.9%, vs 46.2%), as well as children with cardiac conditions (46.9% vs. 14.4%), both <i>p</i> < 0.001. Severe desaturation or severe TIAE occurred in 23.7% of nasal and 22.5% of oral TI (non-adjusted <i>p</i> = 0.408). With PS matching, the prevalence of severe desaturation and or severe adverse TIAEs was 23.6% of nasal vs. 19.8% of oral TI (absolute difference 3.8%, 95% confidence interval (CI): - 0.07, 7.7%), <i>p</i> = 0.055. First attempt success rate was 72.1% of nasal TI versus 69.2% of oral TI, <i>p</i> = 0.072. With PS matching, the success rate was not different between two groups (nasal 72.2% vs. oral 71.5%, <i>p</i> = 0.759).</p><p><strong>Conclusion: </strong>In this large international prospective cohort study, the risk of severe peri-intubation complications was not significantly higher. Nasal TI is used in a minority of TI in PICUs, with substantial differences in patient, provider, and practice compared to oral TI.A prospective multicenter trial may be warranted to address the potential selection bias and to confirm the safety of nasal TI.</p>","PeriodicalId":73402,"journal":{"name":"Intensive care medicine. 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The risks and benefits of nasal TI are not well quantified. As such, safety and descriptive data regarding this practice are warranted.</p><p><strong>Methods: </strong>We evaluated the association between TI route and safety outcomes in a prospectively collected quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from 2013 to 2020. The primary outcome was severe desaturation (SpO<sub>2</sub> > 20% from baseline) and/or severe adverse TI-associated events (TIAEs), using NEAR4KIDS definitions. To balance patient, provider, and practice covariates, we utilized propensity score (PS) matching to compare the outcomes of nasal vs. oral TI.</p><p><strong>Results: </strong>A total of 22,741 TIs [nasal 870 (3.8%), oral 21,871 (96.2%)] were reported from 60 PICUs. Infants were represented in higher proportion in the nasal TI than the oral TI (75.9%, vs 46.2%), as well as children with cardiac conditions (46.9% vs. 14.4%), both <i>p</i> < 0.001. Severe desaturation or severe TIAE occurred in 23.7% of nasal and 22.5% of oral TI (non-adjusted <i>p</i> = 0.408). With PS matching, the prevalence of severe desaturation and or severe adverse TIAEs was 23.6% of nasal vs. 19.8% of oral TI (absolute difference 3.8%, 95% confidence interval (CI): - 0.07, 7.7%), <i>p</i> = 0.055. First attempt success rate was 72.1% of nasal TI versus 69.2% of oral TI, <i>p</i> = 0.072. With PS matching, the success rate was not different between two groups (nasal 72.2% vs. oral 71.5%, <i>p</i> = 0.759).</p><p><strong>Conclusion: </strong>In this large international prospective cohort study, the risk of severe peri-intubation complications was not significantly higher. Nasal TI is used in a minority of TI in PICUs, with substantial differences in patient, provider, and practice compared to oral TI.A prospective multicenter trial may be warranted to address the potential selection bias and to confirm the safety of nasal TI.</p>\",\"PeriodicalId\":73402,\"journal\":{\"name\":\"Intensive care medicine. Paediatric and neonatal\",\"volume\":\"2 1\",\"pages\":\"7\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10891187/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Intensive care medicine. 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引用次数: 0
摘要
背景：在儿科重症监护室（PICU）的所有气管插管中，鼻腔气管插管（TI）只占少数。鼻腔气管插管的风险和益处尚未得到很好的量化。因此，有必要提供有关这种做法的安全性和描述性数据：我们评估了 2013 年至 2020 年期间前瞻性收集的质量改进数据库（全国儿童紧急气道注册：NEAR4KIDS）中 TI 途径与安全结果之间的关联。根据 NEAR4KIDS 的定义，主要结果是严重不饱和（SpO2 与基线相比 > 20%）和/或严重不良 TI 相关事件 (TIAE)。为了平衡患者、医疗服务提供者和实践协变量，我们利用倾向得分（PS）匹配来比较鼻腔和口腔 TI 的结果：60 个 PICU 共报告了 22,741 例 TI [鼻腔 870 例（3.8%），口腔 21,871 例（96.2%）]。婴儿在鼻腔 TI 中的比例高于口腔 TI（75.9% 对 46.2%），患有心脏病的儿童在鼻腔 TI 中的比例也高于口腔 TI（46.9% 对 14.4%），两者的 P = 0.408）。在 PS 匹配的情况下，严重饱和度降低或严重不良 TIAEs 的发生率为：鼻腔 TI 23.6% 对口腔 TI 19.8%（绝对差异 3.8%，95% 置信区间 (CI)：- 0.07，7.7%），P = 0.055。鼻腔 TI 的首次尝试成功率为 72.1%，而口腔 TI 为 69.2%，P = 0.072。在 PS 匹配的情况下，两组的成功率没有差异（鼻腔 72.2% 对口腔 71.5%，P = 0.759）：结论：在这项大型国际前瞻性队列研究中，发生严重插管周围并发症的风险并没有明显增加。鼻腔插管术在 PICU 的插管术中只占少数，与口腔插管术相比，鼻腔插管术在患者、提供者和实践方面存在很大差异。可能需要进行前瞻性多中心试验，以解决潜在的选择偏差并确认鼻腔插管术的安全性。
Safety of primary nasotracheal intubation in the pediatric intensive care unit (PICU).
Background: Nasal tracheal intubation (TI) represents a minority of all TI in the pediatric intensive care unit (PICU). The risks and benefits of nasal TI are not well quantified. As such, safety and descriptive data regarding this practice are warranted.
Methods: We evaluated the association between TI route and safety outcomes in a prospectively collected quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from 2013 to 2020. The primary outcome was severe desaturation (SpO2 > 20% from baseline) and/or severe adverse TI-associated events (TIAEs), using NEAR4KIDS definitions. To balance patient, provider, and practice covariates, we utilized propensity score (PS) matching to compare the outcomes of nasal vs. oral TI.
Results: A total of 22,741 TIs [nasal 870 (3.8%), oral 21,871 (96.2%)] were reported from 60 PICUs. Infants were represented in higher proportion in the nasal TI than the oral TI (75.9%, vs 46.2%), as well as children with cardiac conditions (46.9% vs. 14.4%), both p < 0.001. Severe desaturation or severe TIAE occurred in 23.7% of nasal and 22.5% of oral TI (non-adjusted p = 0.408). With PS matching, the prevalence of severe desaturation and or severe adverse TIAEs was 23.6% of nasal vs. 19.8% of oral TI (absolute difference 3.8%, 95% confidence interval (CI): - 0.07, 7.7%), p = 0.055. First attempt success rate was 72.1% of nasal TI versus 69.2% of oral TI, p = 0.072. With PS matching, the success rate was not different between two groups (nasal 72.2% vs. oral 71.5%, p = 0.759).
Conclusion: In this large international prospective cohort study, the risk of severe peri-intubation complications was not significantly higher. Nasal TI is used in a minority of TI in PICUs, with substantial differences in patient, provider, and practice compared to oral TI.A prospective multicenter trial may be warranted to address the potential selection bias and to confirm the safety of nasal TI.
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