Tracheal Intubation by Advanced Practice Registered Nurses in Pediatric Critical Care: Retrospective Study From the National Emergency Airway for Children Registry (2015-2019).

Autor:	Van Damme DM; 'Just For Kids' Critical Care Center, Norton Children's Hospital, Louisville, KY., McRae EM; 'Just For Kids' Critical Care Center, Norton Children's Hospital, Louisville, KY.; School of Nursing, University of Louisville, Louisville, KY., Irving SY; School of Nursing, University of Pennsylvania, Philadelphia, PA.; Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia PA., Kelly SP; Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR., Tarquinio KM; Pediatric Critical Care Medicine, Department of Pediatrics, Emory University/Children's Healthcare of Atlanta, Atlanta, GA., Giuliano JS Jr; Pediatric Critical Care Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT., Ruppe MD; 'Just For Kids' Critical Care Center, Norton Children's Hospital, Louisville, KY.; Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY., Kierys KL; Pediatric Critical Care, Penn State Health, Hershey, PA., Breuer RK; Critical Care Medicine, Oishei Children's Hospital, University at Buffalo, Buffalo, NY., Parsons SJ; Section of Critical Care, Alberta Children's Hospital, Calgary, AB, Canada., Mallory PP; Division of Pediatric Critical Care, Department of Pediatrics, Duke University, Durham, NC., Shenoi AN; Pediatric Critical Care, Department of Pediatrics, University of Kentucky, Lexington, KY., Swain KA; Pediatric Critical Care/Pediatric Cardiac ICU, Duke University, Durham, NC., Polikoff LA; Pediatric Critical Care Medicine, The Warren Alpert Medical School of Brown University, Providence, RI., Lee A; Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH., Adu-Darko MA; Pediatric Critical Care, University of Virginia, Charlottesville, VA., Napolitano N; Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA., Shults J; Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Nishisaki A; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.; Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA., Berkenbosch JW; 'Just For Kids' Critical Care Center, Norton Children's Hospital, Louisville, KY.; Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville School of Medicine, Louisville, KY.
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2024 Feb 01; Vol. 25 (2), pp. 139-146. Date of Electronic Publication: 2023 Oct 26.
DOI:	10.1097/PCC.0000000000003386
Abstrakt:	Objectives: To describe tracheal intubation (TI) practice by Advanced Practice Registered Nurses (APRNs) in North American PICUs, including rates of TI-associated events (TIAEs) from 2015 to 2019. Design/setting: Retrospective study using the National Emergency Airway Registry for Children with all TIs performed in PICU and pediatric cardiac ICU between January 2015 and December 2019. The primary outcome was first attempt TI success rate. Secondary outcomes were TIAEs, severe TIAEs, and hypoxemia. Subjects: Critically ill children requiring TI in a PICU or pediatric cardiac ICU. Interventions: None. Measurements and Main Results: Among 11,012 TIs, APRNs performed 1,626 (14.7%). Overall, TI by APRNs, compared with other clinicians, occurred less frequently in patients with known difficult airway (11.1% vs. 14.3%; p < 0.001), but more frequently in infants younger than 1 year old (55.9% vs. 44.4%; p < 0.0001), and in patients with cardiac disease (26.3% vs. 15.9%; p < 0.0001).There was lower odds of success in first attempt TI for APRNs vs. other clinicians (adjusted odds ratio, 0.70; 95% CI, 0.62-0.79). We failed to identify a difference in rates of TIAE, severe TIAE, and oxygen desaturation events for TIs by APRNs compared with other clinicians. The TI first attempt success rate improved with APRN experience (< 1 yr: 54.2%, 1-5 yr: 59.4%, 6-10 yr: 67.6%, > 10 yr: 63.1%; p = 0.021). Conclusions: TI performed by APRNs was associated with lower odds of first attempt success when compared with other ICU clinicians although there was no appreciable difference in procedural adverse events. There appears to be a positive relationship between experience and success rates. These data suggest there is an ongoing need for opportunities to build on TI competency with APRNs. Competing Interests: Dr. Polikoff received funding from Novavax. Drs. Napolitano’s and Shults’s institutions received funding from the Agency for Healthcare Research and Quality (AHRQ) (R18HS024511). Dr. Napolitano’s institution received funding from Drager, Timpel, Respironics, Actuated Medical, and Vero-Biotech. Dr. Shults received support for article research from the AHRQ (R18HS024511). Dr. Berkenbosch received funding from Pfizer. Dr. Nishisaki’s institution received funding from the AHRQ, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Chiesi USA; she received support for article research from the AHRQ. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.)
Databáze:	MEDLINE
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