title: Emergent endotracheal intubations in children: be careful if it's late when you intubate.
abstract: OBJECTIVE
  Emergent endotracheal intubations carry a high risk of morbidity and mortality in critically ill adults. Although children may be at higher risk during this procedure as a result of age-related differences in anatomy and physiology, this has not been previously examined. The purpose of this study was to delineate the risks of emergent endotracheal intubations in children.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A 122-bed free-standing children's hospital.
  
  
  METHODS
  We conducted a retrospective review of all intubations occurring outside of the operating room setting between October 2005 and October 2007. Elective intubations were excluded. Intubations were classified as emergent after review of the child's vital signs, blood gas values, and written documentation by nurses, respiratory therapists, and physicians. Intubations occurring on weekends or between 5 pm and 8 am on weekdays were categorized as "off-hours."
  
  
  METHODS
  None.
  
  
  RESULTS
  During the study period, 137 intubations were performed, 77 of which (56%) were emergent. Emergent endotracheal intubations were significantly more likely to occur off-hours (odds ratio, 2.0; 95% confidence interval, 1.1-4.1) and to be associated with a complication (odds ratio, 3.0; 95% confidence interval, 1.4-6.1). Complications occurred in 41% of all intubations. The most common complications were desaturations (29% of all intubations), hypotension (16%), and bradycardia (7%). In a multivariate logistic regression analysis, emergent intubation, off-hours intubation, three or more attempts at intubation, smaller endotracheal tube size, and admission for cardiovascular disease all increased the likelihood of experiencing a complication during intubation. Complications were not associated with an indication for intubation or baseline chronic disease of the child and were not associated with prolonged intensive care unit course or duration of mechanical ventilation.
  
  
  CONCLUSIONS
  Emergent endotracheal intubations are commonly performed in children, are two times more likely to occur off-hours, and are associated with three times the risk of complications as nonemergent intubations.
authors.affiliation: Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA. ccarrol@ccmckids.org
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Carroll
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
authors.forename: John M
authors.initials: JM
authors.lastname: Corsi
authors.forename: Petronella
authors.initials: P
authors.lastname: Stoltz
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Zucker
mesh_terms: D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment