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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1756715
Original Article

The Association of Teamwork and Adverse Tracheal Intubation–Associated Events in Advanced Airway Management in the PICU

John F. Jennings
1   Division of Pediatric Critical Care, Department of Pediatrics, Cohen Children's Medical Center, New York City, New York, United States
,
Sholeen Nett
2   Division of Pediatric Critical Care, Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
,
Rachel Umoren
3   Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington, United States
,
Robert Murray
4   Division of Critical Care, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Aaron Kessel
1   Division of Pediatric Critical Care, Department of Pediatrics, Cohen Children's Medical Center, New York City, New York, United States
,
Natalie Napolitano
5   Department of Respiratory Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Michelle Adu-Darko
6   Department of Pediatric Critical Care, University of Virginia Children's Hospital, Charlottesville, Virginia, United States
,
Katherine Biagas
7   Department of Pediatric Critical Care Medicine, The Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
,
Philipp Jung
8   Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
,
Debra Spear
9   Department of Pediatric Critical Care, Penn State Health, Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
,
Simon Parsons
10   Division of Critical Care, Alberta Children's Hospital, Calgary, Canada
,
Ryan Breuer
11   Division of Pediatric Critical Care, Department of Pediatric Critical Care Medicine, University of Buffalo, Oishei Children's Hospital, Buffalo, New York, United States
,
Keith Meyer
12   Division of Critical Care Medicine, Nicklaus Children's Hospital/Herbert Wertheim College of Medicine Florida International University, Miami, Florida, United States
,
Matthew Malone
13   Division of Critical Care Medicine, Department of Pediatrics, The University of Arkansas for Medical Sciences/Arkansas Children's Hospital, Little Rock, Arkansas, United States
,
Asha Shenoi
14   Department of Pediatrics, Heinrich A. Werner Division of Pediatric Critical Care Medicine, University of Kentucky School of Medicine, Lexington, Kentucky, United States
,
Anthony Lee
15   Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Palen Mallory
16   Department of Pediatrics, Duke University, Durham, North Carolina, United States
,
Awni Al-Subu
17   Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
,
Keiko Tarquinio
18   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Lily Glater
19   Division of Pediatric Critical Care, Department of Pediatrics, Steven & Alexandra Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
,
Megan Toal
20   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York City, New York, United States
,
Jan Hau Lee
21   Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
,
Matthew Pinto
22   Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, United States
,
Lee Polikoff
23   Division of Pediatric Critical Care Medicine, The Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, United States
,
Erin Own
24   Department of Pediatric Critical Care Medicine, University of Louisville and Norton Children's Hospital, Louisville, Kentucky, United States
,
Iris Toedt-Pingel
25   Department of Pediatrics, University of Vermont Children's Hospital, Burlington, Vermont, United States
,
Mioko Kasagi
26   Department of Pediatric Critical & Emergency Care Medicine, Tokyo Metropolitan Children's Hospital, Tokyo, Japan
,
Laurence Ducharme-Crevier
27   Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
,
Makoto Motomura
28   Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Aichi, Japan
,
Masafumi Gima
29   Department of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
,
Serena Kelly
30   Department of Pediatrics, Pediatric Critical Care, OHSU, Doernbecher Children's Hospital, Portland, Oregon, United States
,
Josep Panisello
31   Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale University Medical School, New Haven, Connecticut, United States
,
Gabrielle Nuthall
32   Department of Pediatric Critical Care, Starship Children's Hospital, Auckland, New Zealand
,
Kelsey Gladen
33   Division of Pediatric Critical Care, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, Arizona, United States
,
Justine Shults
34   Division of Biostatistics, Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Vinay Nadkarni
35   Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
36   Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Akira Nishisaki
35   Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
36   Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
for the National Emergency Airway Registry for Children (NEAR4KIDS) Investigators Pediatric Acute Lung Injury Sepsis Investigators (PALISI) Network › Author Affiliations
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Abstract

Tracheal intubation (TI) in critically ill children is a life-saving but high-risk procedure that involves multiple team members with diverse clinical skills. We aim to examine the association between the provider-reported teamwork rating and the occurrence of adverse TI-associated events (TIAEs). A retrospective analysis of prospectively collected data from 45 pediatric intensive care units in the National Emergency Airway Registry for Children (NEAR4KIDS) database from January 2013 to March 2018 was performed. A composite teamwork score was generated using the average of each of five (7-point Likert scale) domains in the teamwork assessment tool. Poor teamwork was defined as an average score of 4 or lower. Team provider stress data were also recorded with each intubation. A total of 12,536 TIs were reported from 2013 to 2018. Approximately 4.1% (n = 520) rated a poor teamwork score. TIs indicated for shock were more commonly associated with a poor teamwork score, while those indicated for procedures and those utilizing neuromuscular blockade were less commonly associated with a poor teamwork score. TIs with poor teamwork were associated with a higher occurrence of adverse TIAE (24.4% vs 14.4%, p < 0.001), severe TIAE (13.7% vs 5.9%, p < 0.001), and peri-intubation hypoxemia < 80% (26.4% vs 17.9%, p < 0.001). After adjusting for indication, provider type, and neuromuscular blockade use, poor teamwork was associated with higher odds of adverse TIAEs (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.35–2.34), severe TIAEs (OR, 2.23; 95% CI, 1.47–3.37), and hypoxemia (OR, 1.63; 95% CI, 1.25–2.03). TIs with poor teamwork were independently associated with a higher occurrence of TIAEs, severe TIAEs, and hypoxemia.

Keywords

child - airway - safety - teamwork - communication

Funding

This study was supported by AHRQ R18HS024511.


N. N., J. S., V. N., and A. N. were supported by AHRQ R18HS024511.




Publication History

Received: 13 May 2022

Accepted: 31 July 2022

Article published online:
07 October 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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