title: Airway management in pediatric patients at referring hospitals compared to a receiving tertiary pediatric ICU.
abstract: OBJECTIVE
  To describe the current practice of pediatric airway management at referring hospitals and the associated adverse events compared to a receiving tertiary pediatric ICU.
  
  
  METHODS
  Retrospective chart and transport record review of all emergency critical care transports to our Pediatric ICU over 3 years. Data regarding tracheal intubation procedure, pre-defined adverse Tracheal Intubation Associated Events (TIAEs), and airway events before, during, and after the inter-hospital transport were collected using a standard National Emergency Airway Registry for children (NEAR4KIDS) definition. Tracheal intubation outcomes were compared to in-hospital P ICU intubations.
  
  
  RESULTS
  253/1489 (17%) of critical care transports had airway management, all by tracheal intubation. The most common condition was seizure (34%), followed by pulmonary/lower airway disease (16%). 49 (19%) had TIAEs; the most common event was mainstem bronchial intubation (13%). Incidence of TIAEs was similar to PICU (p=0.69). Thirteen had an inappropriate tracheal tube position upon PICU arrival, but none experienced accidental extubation during transport. An uncuffed tracheal tube was used in 108/172 (63%) of patients<8 years, significantly higher than PICU (20%, p<0.0001). 124 (49%) were extubated within 24 h, 153 (60%) within 48 h. Two patients had the tracheal tube changed to cuffed from uncuffed due to air leak.
  
  
  CONCLUSIONS
  Provider reported adverse TIAEs are common during airway management in children requiring critical care transport, but not higher compared to PICU intubations. Most inter-hospital transport patients are intubated with an uncuffed tracheal tube. Subsequent tracheal tube change from uncuffed to cuffed tube is rarely required.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, United States. Nishisaki@email.chop.edu
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
authors.forename: Nitin
authors.initials: N
authors.lastname: Marwaha
authors.forename: Vasantha
authors.initials: V
authors.lastname: Kasinathan
authors.forename: Peter
authors.initials: P
authors.lastname: Brust
authors.forename: Calvin A
authors.initials: CA
authors.lastname: Brown
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Ron M
authors.initials: RM
authors.lastname: Walls
authors.forename: Nicholas
authors.initials: N
authors.lastname: Tsarouhas
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
mesh_terms: D058109:Airway Management / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D012017:Referral and Consultation; D012131:Respiratory Insufficiency / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome