695: EVALUATING AIRWAY MANAGEMENT IN PATIENTS WITH TRISOMY 21 IN THE PEDIATRIC INTENSIVE CARE UNIT

Abstract

Introduction: Children with Trisomy 21 (T21) are known to have anatomic and physiologic abnormalities that may complicate tracheal intubation. However, current tracheal intubation (TI) practice in critically ill children with T21 is not well described. We sought to describe TI practice in critically ill children with T21. We hypothesize the Adverse Airway Outcomes: AAOs (adverse TI associated events: TIAEs and/or peri-intubation hypoxemia: >20% decrease in SpO2) are higher in children with T21 as compared to those without T21. Methods: Multicenter airway management quality improvement database (NEAR4KIDS) was queried. In addition, we collected patient’s T21 status, cervical spine and cardiac conditions. The association between T21 status and occurrence of AAOs was evaluated using Chi2 and multivariable logistic regression adjusting for patient, provider, and practice covariates. Results: Of the 8401 TI encounters from 15 pediatric general/cardiac ICUs between 2014-2020, 274 (3.3%) were TIs in patients with T21. Among those with T21, 84% had congenital heart disease, and 4% had atlantoaxial instability with cervical spine protection used in 6%. Patients with T21 were smaller (median (IQR) weight 7.8 (4.5-14.7) kg vs 10.6 (5.2-25) kg, p< 0.001). Patients with T21 (vs without) were more commonly urgently intubated for oxygenation (46% vs 32%, p< 0.001) and ventilation failure (41% vs 35%, p=0.04) as opposed to elective procedural intubations. Patients with T21 had more difficult airway features (35% vs 25%, p=0.001), including upper airway obstruction (14% vs 8%, p=0.001). Patients with T21 were more likely to receive atropine (34% vs 26%, p=0.004) and less likely intubated with video laryngoscopy (30% vs 37%, p=0.023). AAOs occurred similarly between those with T21 vs without (26% vs. 24%, p=0.669); adverse TIAEs occurred less in T21 (9% vs 14%, p=0.02), but hypoxemia occurred more frequently (23% vs 18%, p=0.046). After adjusting for age, indication, provider, device, paralytic, and apneic oxygenation, T21 condition was not associated with increased AAOs (OR 0.91, 95% CI 0.69-1.21, p=0.53). Conclusions: T21 condition was not associated with higher adverse airway outcomes. Patients with T21 were intubated more frequently for respiratory failure and with atropine and less frequently with video laryngoscopy.