title: A National Emergency Airway Registry for children: landscape of tracheal intubation in 15 PICUs.
abstract: OBJECTIVE
  To characterize the landscape of process of care and safety outcomes for tracheal intubation across pediatric intensive care units
  
  
  BACKGROUND
  Procedural process of care and safety outcomes of tracheal intubation across pediatric intensive care units has not been described. We hypothesize that the novel National Emergency Airway Registry for Children registry is a feasible tool to capture tracheal intubation process of care and outcomes.
  
  
  METHODS
  Prospective, descriptive.
  
  
  METHODS
  Fifteen academic PICUs in North America.
  
  
  METHODS
  Critically ill children requiring tracheal intubation in PICUs.
  
  
  METHODS
  Tracheal intubation quality improvement data were prospectively collected for all initial tracheal intubation in 15 PICUs from July 2010 to December 2011 using the National Emergency Airway Registry for Children tool with explicit site-specific compliance plans and operational definitions including adverse tracheal intubation associated events.
  
  
  RESULTS
  One thousand seven hundred fifteen tracheal intubation encounters were reported (averaging 1/3.4 days, or 1/86 bed days). Ninety-eight percent of primary tracheal intubation were successful; 86% were successful with less than or equal to two attempts. First attempt was by pediatric residents in 23%, pediatric critical care fellows in 41%, and critical care attending physicians in 13%: first attempt success rate was 62%, first provider success rate was 79%. The first method was oral intubation in 1,659 (98%) and nasal in 55 (2%). Direct laryngoscopy was used in 96%. Ninety percent of tracheal intubation were with cuffed tracheal tubes. Adverse tracheal intubation associated events were reported in 20% of intubations (n = 372), with severe tracheal intubation associated events in 6% (n = 115). Esophageal intubation with immediate recognition was the most common tracheal intubation associated events (n = 167, 9%). History of difficult airway, diagnostic category, unstable hemodynamics, and resident provider as first airway provider were associated with occurrence of tracheal intubation associated events. Severe tracheal intubation associated events were associated with diagnostic category and pre-existing unstable hemodynamics. Elective tracheal intubation status was associated with fewer severe tracheal intubation associated events.
  
  
  CONCLUSIONS
  National Emergency Airway Registry for Children was feasible to characterize PICU tracheal intubation procedural process of care and safety outcomes. Self-reported adverse tracheal intubation associated events occurred frequently and were associated with patient, provider, and practice characteristics.
authors: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, PA, USA. Nishisaki@email.chop.edu
authors: Akira
authors: A
authors: Nishisaki
authors: David A
authors: DA
authors: Turner
authors: Calvin A
authors: CA
authors: Brown
authors: Ron M
authors: RM
authors: Walls
authors: Vinay M
authors: VM
authors: Nadkarni
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D009656:North America; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012042:Registries