Abstract
BackgroundThe goal of this study was to determine if difficult airway risk factors were similar in children cared for by the difficult airway response team (DART) and those cared for by the rapid response team (RRT).MethodsIn this retrospective database analysis of prospectively collected data, we analyzed patient demographics, comorbidities, history of difficult intubation, and intubation event details, including time and place of the emergency and devices used to successfully secure the airway.ResultsWithin the 110-patient cohort, median age (IQR) was higher among DART patients than among RRT patients [8.5 years (0.9-14.6) versus 0.3 years (0.04-3.6); P < 0.001]. The odds of DART management were higher for children ages 1-2 years (aOR, 43.3; 95% CI: 2.73-684.3) and >5 years (aOR, 13.1; 95% CI: 1.85-93.4) than for those less than one-year-old. DART patients were more likely to have craniofacial abnormalities (aOR, 51.6; 95% CI: 2.50-1065.1), airway swelling (aOR, 240.1; 95% CI: 13.6-4237.2), or trauma (all DART managed). Among patients intubated by the DART, children with a history of difficult airway were more likely to have musculoskeletal (P = 0.04) and craniofacial abnormalities (P < 0.001), whereas children without a known history of difficult airway were more likely to have airway swelling (P = 0.04).ConclusionSpecific clinical risk factors predict the need for emergency airway management by the DART in the pediatric hospital setting. The coordinated use of a DART to respond to difficult airway emergencies may limit attempts at endotracheal tube placement and mitigate morbidity.
Highlights
Difficult airways in children are rare; airway-related complications are a significant cause of morbidity and mortality
The odds of difficult airway response team (DART) management were higher for children ages 1-2 years and >5 years than for those less than one-year-old
The pediatric rapid response team (RRT) consists of an intensivist, a pediatric intensive care unit (PICU) fellow, a respiratory therapist, and a pediatric nurse, and intubation is performed by the in-house PICU fellow or attending
Summary
Difficult airways in children are rare; airway-related complications are a significant cause of morbidity and mortality. A 2014 publication reported that outside the OR, in the pediatric intensive care unit (PICU), approximately 9% of all tracheal intubations could be classified as difficult, requiring three or more attempts [3]. Senior-level practitioners performed most of the initial intubation attempts in such cases (81%), yet severe adverse events, including cardiac arrest, esophageal intubation with delayed recognition, and emesis with witnessed aspiration, remained high, at 13%. Both the Joint Commission on Accreditation of Healthcare Organizations and the Institute for Healthcare Improvement via the 100,000 Lives Campaign recommend that hospitals have “a system of rapid response teams (RRTs) to bring skilled resources” [4]. The goal of this study was to determine if difficult airway risk factors were similar in children cared for by the difficult airway response team (DART) and those cared for by the rapid response team (RRT)
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