An international national emergency airway registry for children: Comparison of tracheal intubation practices across international PICUs

Abstract

An international national emergency airway registry for children: Comparisonof tracheal intubationpractices across international PICUs Jan hau Lee, Gabrielle Nuthall, Takanari Ikeyama, Osamu Saito, Yee hui Mok, Vinay M. Nadkarni, Akira Nishisaki KK Women's and Children's Hospital, Singapore Starship Children's Hospital, New Zealand Aichi Children's Health and Medical Center, Japan Tokyo Metropolitan Children's Medical Center, Japan The Children's Hospital of Philadelphia, USA Background/Purpose: Tracheal intubation (TI) is a common, lifesaving intervention in pediatric intensive care units (PICUs). There is heterogeneity in approaches to TI across PICUs. This variation may be more marked across different geographical regions and may lead to difference in safety outcomes. We hypothesized that there would be differences in the process of care and safety outcomes for TI across PICUs in 4 different geographical regions (Japan, New Zealand, Singapore, and North America). Methods: The multicenter TI safety database National Emergency Airway Registry for Children (NEAR4KIDS) expanded to include international PICUs since 2012. Currently, there are 3 international PICUs outside of North America. We analyzed data from the NEAR4KIDS database from 3 PICUs (1 in Japan, 1 in New Zealand, and 1 in Singapore) from January 2013 to September 2014 and compared against North America (25 ICUs). We included all initial TI courses performed in PICUs. Outcome measures included adverse tracheal intubation associated events (TIAEs) and severe TIAEs (eg, cardiac arrest, aspiration, esophageal intubation not immediately recognized). Univariate analysis was performed with χ test and Kruskal-Wallis test, with P b .05 taken as statistical difference. Results: We identified a total of 515 TIs across the 3 international PICUs. Median age of patients (years) was 0 (IQR, 0-2) in Japan, 0 (0-1) in New Zealand, and 1 (0-5) in Singapore, significantly different (P = .005). The most common TI indication was respiratory failure (74% in Japan, 62% in New Zealand, 68% in Singapore, P = .17), similar to TIs from North America (62%). Direct laryngoscopy was the most common TI method in both international and North America (96% vs 85%, P b .001). International PICUs used uncuffed tracheal tube more often (62% vs 7%, P b .001). Among the reported TIs, tube change was more common in international sites (36% vs 12%, P b .001). The occurrence of adverse TIAE was 20% in Japan, 14% in New Zealand, and 10% in Singapore, not different from North America (international 15% vs North America 16%, P= .64). The occurrence of severe TIAEswas 11% in Japan, 6% in New Zealand, and 2% in Singapore, not different fromNorth America (international 7% vs North America 6%, P = .73). Conclusions: NEAR4KIDS TI registry successfully captured similarities and differences in TI practice and outcomes across international PICUs. International sites used uncuffed tracheal tube more often and had higher proportionof tracheal tube change. Theoccurrenceof TIAEand severeTIAEs were similar between international and North American sites.