PURPOSE:Emergent endotracheal intubations carry a high risk of morbidity and mortality in critically ill adults. Children may be at higher risk for complications during this procedure due to their physiology. However, the incidence of these complications and associated factors has not been examined previously. The purpose of this study was to characterize emergent endotracheal intubation in critically ill children.
METHODS:We conducted a retrospective review of all children who underwent intubation in a pediatric intensive care unit between October 2005–2007. Emergent endotracheal intubations were defined after review of the child’s vital signs, blood gas values, and written documentation by nurses, respiratory therapists and physicians. Off-hours was defined as occurring on weekends or between 5pm-8am on weekdays.
RESULTS:During the study period, 137 non-elective intubations were performed; 56% (n=77) of which were emergent. Emergent endotracheal intubations were significantly more likely to occur off-hours (OR 2.0; 95% CI 1.1, 4.1) and to be associated with a complication (OR 3.0; 95% CI 1.4, 6.1) than non-emergent intubations. Complications occurred in 41% of all intubations. The most common complications were desaturations (29% of all intubations), hypotension (16%), and bradycardia (7%). Complications were significantly more likely to occur in males (OR 2.3; 95% CI 1.1, 4.6), in children admitted with cardiovascular disease (OR 6.6; 95% CI 1.3, 32.3), and in children who had ≥ 3 attempts of intubation (OR 3.2; 95% CI 1.2, 8.6). Complications were not associated with indication for intubation, or with chronic disease of the child. The use of neuromuscular blockade was common during these procedures (86%), and more likely to be used during non-emergent intubations (OR 3.4; 95% CI 1.1, 10.8).
CONCLUSION:Emergent endotracheal intubations are common in the pediatric ICU, are more likely to occur off-hours, and are associated with a higher incidence of complications than non-emergent intubations.
CLINICAL IMPLICATIONS:Reducing the incidence of emergent endotracheal intubation, possibly with measures to improve off-hours intensive care unit coverage, would decrease the incidence of complications in critically ill children.
DISCLOSURE:Christopher Carroll, None.