title: Family Presence During Pediatric Tracheal Intubations.
abstract: OBJECTIVE
  Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal intubation (TI) in pediatric intensive care units (PICUs). Family presence during procedures in PICUs has been advocated.
  
  
  OBJECTIVE
  To describe the current practice of FP during TI and evaluate the association with procedural and clinician (including physician, respiratory therapist, and nurse practitioner) outcomes across multiple PICUs.
  
  
  METHODS
  Prospective cohort study in which all TIs from July 2010 to March 2014 in the multicenter TI database (National Emergency Airway Registry for Children [NEAR4KIDS]) were analyzed. Family presence was defined as a family member present during TI. This study included all TIs in patients younger than 18 years in 22 international PICUs.
  
  
  METHODS
  Family presence and no FP during TI in the PICU.
  
  
  METHODS
  The percentage of FP during TIs. First attempt success rate, adverse TI-associated events, multiple attempts (≥ 3), oxygen desaturation (oxygen saturation as measured by pulse oximetry <80%), and self-reported team stress level.
  
  
  RESULTS
  A total of 4969 TI encounters were reported. Among those, 81% (n = 4030) of TIs had documented FP status (with/without). The median age of participants with FP was 2 years and 1 year for those without FP. The average percentage of TIs with FP was 19% and varied widely across sites (0%-43%; P < .001). Tracheal intubations with FP (vs without FP) were associated with older patients (median, 2 years vs 1 year; P = .04), lower Paediatric Index of Mortality 2 score, and pediatric resident as the first airway clinician (23%, n = 179 vs 18%, n = 584; odds ratio [OR], 1.4; 95% CI, 1.2-1.7). Tracheal intubations with FP and without FP were no different in the first attempt success rate (OR, 1.00; 95% CI, 0.85-1.18), adverse TI-associated events (any events: OR, 1.06; 95% CI, 0.85-1.30 and severe events: OR, 1.04; 95% CI, 0.75-1.43), multiple attempts (≥ 3) (OR, 1.03; 95% CI, 0.82-1.28), oxygen desaturation (oxygen saturation <80%) (OR, 0.97; 95% CI, 0.80-1.18), or self-reported team stress level (OR, 1.09; 95% CI, 0.92-1.31). This result persisted after adjusting for patient and clinician confounders.
  
  
  CONCLUSIONS
  Wide variability exists in FP during TIs across PICUs. Family presence was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (<80%), or higher team stress level. Our data suggest that FP during TI can safely be implemented as part of a family-centered care model in the PICU.
authors.affiliation: Section of Pediatric Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Sanders
authors.affiliation: Division of Pediatric Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Sholeen T
authors.initials: ST
authors.lastname: Nett
authors.affiliation: Center for Pediatric Nursing Research and Evidence Based Practice, Department of Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Katherine Finn
authors.initials: KF
authors.lastname: Davis
authors.affiliation: Department of Pediatrics, Pediatric Critical Care Medicine, Stony Brook Children's Hospital, Stony Brook, New York.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Parker
authors.affiliation: Pediatric Acute Care Associates of North Texas PLLC, Medical City Children's Hospital, Dallas.
authors.forename: G Kris
authors.initials: GK
authors.lastname: Bysani
authors.affiliation: University of Virginia Children's Hospital, Charlottesville.
authors.forename: Michelle
authors.initials: M
authors.lastname: Adu-Darko
authors.affiliation: Division of Cardiac Critical Care Medicine, Department of Pediatrics and Anesthesia/Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Bird
authors.affiliation: Division of Critical Care, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina.
authors.forename: Ira M
authors.initials: IM
authors.lastname: Cheifetz
authors.affiliation: Penn State Hershey Children's Hospital, Hershey, Pennsylvania.
authors.forename: Ashley T
authors.initials: AT
authors.lastname: Derbyshire
authors.affiliation: Sainte-Justine University Hospital Center, Montreal, Quebec, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Emeriaud
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: John S
authors.initials: JS
authors.lastname: Giuliano
authors.affiliation: Pediatric Critical Care Medicine, Children's Hospital of Central California, Fresno.
authors.forename: Ana Lia
authors.initials: AL
authors.lastname: Graciano
authors.affiliation: Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hagiwara
authors.affiliation: Section of Pediatric Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock.
authors.forename: Glenda
authors.initials: G
authors.lastname: Hefley
authors.affiliation: Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors.forename: Takanari
authors.initials: T
authors.lastname: Ikeyama
authors.affiliation: Division of Pediatric Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: J Dean
authors.initials: JD
authors.lastname: Jarvis
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Children's Hospital of Atlanta, Atlanta, Georgia.
authors.forename: Pradip
authors.initials: P
authors.lastname: Kamat
authors.affiliation: Department of Pediatrics, Division of Pediatric Critical Care, Kentucky Children's Hospital, University of Kentucky School of Medicine, Lexington.
authors.forename: Ashwin S
authors.initials: AS
authors.lastname: Krishna
authors.affiliation: Nationwide Children's Hospital, Ohio State University, Columbus.
authors.forename: Anthony
authors.initials: A
authors.lastname: Lee
authors.affiliation: KK Women's and Children's Hospital, Singapore.
authors.forename: Jan Hau
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Pediatric Intensive Care Unit, Maria Fareri Children's Hospital, Westchester, New York.
authors.forename: Simon
authors.initials: S
authors.lastname: Li
authors.affiliation: Division of Critical Care Medicine, Miami Children's Hospital, Miami, Florida.
authors.forename: Keith
authors.initials: K
authors.lastname: Meyer
authors.affiliation: Division of Critical Care, Department of Pediatrics, University of Louisville and Kosair Children's Hospital, Louisville, Kentucky.
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Montgomery
authors.affiliation: Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nagai
authors.affiliation: Pediatric Intensive Care Unit, Maria Fareri Children's Hospital, Westchester, New York.
authors.forename: Matthew
authors.initials: M
authors.lastname: Pinto
authors.affiliation: Division of Critical Care, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Rehder
authors.affiliation: Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Saito
authors.affiliation: Department of Pediatrics, Division of Pediatric Critical Care, Kentucky Children's Hospital, University of Kentucky School of Medicine, Lexington.
authors.forename: Asha N
authors.initials: AN
authors.lastname: Shenoi
authors.affiliation: Starship Hospital, Auckland, New Zealand.
authors.forename: Hester Christianne
authors.initials: HC
authors.lastname: Taekema
authors.affiliation: Critical Care Medicine, Rhode Island/Hasbro Children's Hospital, Providence.
authors.forename: Keiko M
authors.initials: KM
authors.lastname: Tarquinio
authors.affiliation: Critical Care Medicine and Pediatrics, Pittsburgh Children's Hospital, Pittsburgh, Pennsylvania.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Thompson
authors.affiliation: Division of Critical Care, Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina.
authors.forename: David A
authors.initials: DA
authors.lastname: Turner
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods*; D005190:Family; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D018802:Patient-Centered Care / Q000379:methods*; D011446:Prospective Studies; D012042:Registries