PURPOSE: In adult populations, implementation of in-house, full-time (24 hour/day, 7 day/week) supervision by intensivists is thought to reduce mortality and decrease complication rates. Little is known about the impact of in-house intensivist supervision in children’s hospitals. We recently began providing such coverage in our children’s hospital, and have evaluated its relationship to patient outcomes. Specifically, we sought to determine the influence of in-house intensivist supervision on the incidence of complications in children requiring emergent intubations.
METHODS: We conducted a review of all emergency intubation procedures between October 2005 - October 2007 (pre in-house intensivist supervision) and April 2008 - April 2010 (post in-house intensivist supervision). Procedural complications and outcomes were compared between the two time periods.
RESULTS: In the period preceding in-house intensivist supervision, 137 intubations were performed, 56% (n=77) of which were emergent. After implementation of in-house intensivist supervision, 151 intubations were performed, 52% (n=78) of which were emergent. There were no significant differences in the frequency of emergent intubations, the timing of these intubations (day vs. night), the patient characteristics (age, gender, race), or in admission diseases between the two time periods. There were no significant differences between the two periods in the induction medications used, although neuromuscular blockade was used more frequently in the post in-house attending period (97% vs. 81%; OR 9.2, 95% CI 2.0-41.7). However, there was a significant decrease in the incidence of complications as a result of emergent intubations after implementation of in-house supervision (52% vs. 28%; OR 0.36, 95% CI 0.19-0.71). Specifically, there were significantly lower rates of clinically significant oxygen desaturations (39% vs. 18%; OR 0.34, 95% CI 0.16-0.72) and hypotension (22% vs. 5%; OR 0.19, 95% CI 0.06-0.60) in the post in-house intensivist period.
CONCLUSIONS: Emergent intubations are common in children and are frequently associated with significant complications. In-house intensivist supervision was associated with a more than two-fold reduction in the incidence of these dangerous occurances.
CLINICAL IMPLICATIONS: In-house intensivist supervision is associated with improvement in safety during emergent intubations in children.
DISCLOSURE: The following authors have nothing to disclose: Christopher Carroll, Kathleen Sala, Aaron Zucker
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