Safety of tracheal intubation in the presence of cardiac disease in paediatric ICUs

2018 ◽  
Vol 28 (7) ◽  
pp. 928-937 ◽  
Author(s):  
Eleanor A. Gradidge ◽  
Adnan Bakar ◽  
David Tellez ◽  
Michael Ruppe ◽  
Sarah Tallent ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Heart Disease ◽  
Tracheal Intubation ◽  
Cardiac Disease ◽  
Oxygen Desaturation ◽  
Cardiac Patients ◽  
Haemodynamic Instability ◽  
Emergency Airway ◽  
Acquired Heart Disease ◽  
National Emergency

AbstractIntroductionChildren with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.Materials and methodsWe sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.ResultsA total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.ConclusionsThe overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.

Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study

Resuscitation ◽  
2021 ◽  
Author(s):  
Michael D. April ◽  
Allyson Arana ◽  
Joshua C. Reynolds ◽  
Jestin N. Carlson ◽  
William T. Davis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Emergency Airway ◽  
National Emergency

Impact of Physician Training Level on Neonatal Tracheal Intubation Success Rates and Adverse Events: A Report from National Emergency Airway Registry for Neonates (NEAR4NEOS)

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Lindsay Johnston ◽  
Taylor Sawyer ◽  
Anne Ades ◽  
Ahmed Moussa ◽  
Jeanne Zenge ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Adverse Events ◽  
Multivariable Analysis ◽  
Estimating Equation ◽  
Oxygen Desaturation ◽  
Physician Training ◽  
Training Level ◽  
Success Rates ◽  
Emergency Airway ◽  
Significant Difference

<b><i>Introduction:</i></b> Neonatal tracheal intubation (TI) outcomes have been assessed by role, but training level may impact TI success and safety. Effect of physician training level (PTL) on the first-attempt success, adverse TI-associated events (TIAEs), and oxygen desaturation was assessed. <b><i>Methods:</i></b> Prospective cohort study in 11 international NEAR4NEOS sites between October 2014 and December 2017. Primary TIs performed by pediatric/neonatal physicians were included. Univariable analysis evaluated association between PTL, patient/practice characteristics, and outcomes. Multivariable analysis with generalized estimating equation assessed for independent association between PTL and outcomes (first-attempt success, TIAEs, and oxygen desaturation ≥20%; attending as reference). <b><i>Results:</i></b> Of 2,608 primary TIs, 1,298 were first attempted by pediatric/neonatal physicians. PTL was associated with patient age, weight, comorbidities, TI indication, difficult airway history, premedication, and device. First-attempt success rate differed across PTL (resident 23%, fellow 53%, and attending 60%; <i>p</i> &#x3c; 0.001). There was no statistically significant difference in TIAEs (resident 22%, fellow 20%, and attending 25%; <i>p</i> = 0.34). Desaturation occurred more frequently with residents (60%), compared to fellows and attendings (46 and 53%; <i>p</i> &#x3c; 0.001). In multivariable analysis, adjusted odds ratio of the first-attempt success was 0.18 (95% CI: 0.11–0.30) for residents and 0.80 (95% CI: 0.51–1.24) for fellows. PTL was not independently associated with adjusted odds of TIAEs or severe oxygen desaturation. <b><i>Conclusion:</i></b> Higher PTL was associated with increased first-attempt success but not TIAE/oxygen desaturation. Identifying strategies to decrease adverse events during neonatal TI remains critical.

Comprehensive dental evaluation of children with congenital or acquired heart disease

2012 ◽  
Vol 23 (5) ◽  
pp. 705-710 ◽  
Author(s):  
Kenan Cantekin ◽  
Isin Cantekin ◽  
Yasemin Torun
Keyword(s):  
Heart Disease ◽  
Children And Adolescents ◽  
Oral Hygiene ◽  
Cardiac Disease ◽  
Heart Diseases ◽  
Treatment Plan ◽  
Caries Experience ◽  
Univentricular Heart ◽  
Healthy Children ◽  
Acquired Heart Disease

AbstractObjectiveThe aims of this case–control study were to (a) compare the caries experience and oral hygiene, and (b) quantify the persistence of a delay in the dental age in children with cardiac disease and a group of healthy children.Methods and MaterialsThe study population comprised a group of 268 3- to 16-year-old children and adolescents with a cardiac disease and a group of 268 age- and sex-matched healthy children and adolescents. Specifically, the decayed, missed, and filled teeth indices, simplified oral hygiene index, and the dental ages of the two groups of children were calculated and then compared.ResultsAlthough the oral health of the children with either a congenital or an acquired heart disease was the same as that of the healthy children, there were significant differences in the decayed, missed, and filled teeth indices. Dental ages of the children with a congenital heart disease were significantly lower than those of healthy children. The findings showed that complex univentricular heart diseases had the highest negative impact on dental development (−1.1), followed by complex biventricular (−0.9), simple surgical (−0.5), and mild (−0.4) heart disease patients.ConclusionOnce thorough knowledge of the child's cardiac status is gained, a definitive dental treatment plan for the child with a cardiac disease can be established.

Cardiac disease in pregnancy. Part 2: acquired heart disease

2007 ◽  
Vol 9 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Emily Gelson ◽  
Mark Johnson ◽  
Michael Gatzoulis ◽  
Uebing Abselm
Keyword(s):  
Heart Disease ◽  
Cardiac Disease ◽  
Acquired Heart Disease ◽  
In Pregnancy

Cardiac disease in pregnancy

2020 ◽  
pp. 151-162
Author(s):  
Philip Steer
Keyword(s):  
Heart Disease ◽  
Cardiac Disease ◽  
Developed Countries ◽  
Care Needs ◽  
The United Kingdom ◽  
Risk Of Mortality ◽  
Acquired Heart Disease ◽  
Causes Of Mortality ◽  
Preconception Counselling ◽  
Impaired Cardiac Function

Cardiac disease has become the single most important cause of maternal death in the United Kingdom and other developed countries over the last 30 years, mostly due to acquired heart disease secondary to women having their pregnancies later in life. The main causes of mortality are myocardial infarction/ischaemic heart disease (one-third) and cardiomyopathy (a further third). The remaining deaths are mostly associated with rheumatic heart disease, congenital heart disease, and pulmonary hypertension (about 5–10% each). Pregnancy represents a challenge to women with impaired cardiac function because of the cardiovascular changes associated with the increase in blood supply to the uterus and placenta. Preconception counselling is vital and should cover the risk of mortality, morbidity, and the increased rate of preterm birth and fetal growth restriction in affected women. Antenatal and intrapartum care needs to be planned by a multidisciplinary team and delivered by staff with appropriate expertise.

The New Trainee Effect in Tracheal Intubation Procedural Safety Across PICUs in North America: A Report From National Emergency Airway Registry for Children*

2020 ◽  
Vol 21 (12) ◽  
pp. 1042-1050
Author(s):  
Aline Branca ◽  
David Tellez ◽  
John Berkenbosch ◽  
Kyle J. Rehder ◽  
John S. Giuliano ◽  
...  
Keyword(s):  
North America ◽  
Tracheal Intubation ◽  
Emergency Airway ◽  
National Emergency

An international national emergency airway registry for children: Comparison of tracheal intubation practices across international PICUs

2015 ◽  
Vol 30 (4) ◽  
pp. 854
Author(s):  
Jan hau Lee ◽  
Gabrielle Nuthall ◽  
Takanari Ikeyama ◽  
Osamu Saito ◽  
Yee hui Mok ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Emergency Airway ◽  
National Emergency

scholarly journals Characteristics shifting of heart disease in pregnancy: A report from low middle-income country

2021 ◽  
Author(s):  
Cyntia Puspa Pitaloka ◽  
Absa Secka ◽  
Ernawati Ernawati ◽  
Agus Sulistyono ◽  
Hermanto Tri Juwono ◽  
...  
Keyword(s):  
Developing Countries ◽  
Heart Disease ◽  
Pregnant Women ◽  
Cardiac Disease ◽  
Cardiac Complications ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Acquired Heart Disease ◽  
Heart Disease In Pregnancy ◽  
In Pregnancy

Background: Heart disease in pregnancy is one of the leading causes of maternal mortality and morbidity in developing countries. However, the characteristics of the disease vary between countries and regions. This study aimed to present the characteristics of pregnant women with heart disease in an economically advantageous region of a developing country.Design and methods: A cross-sectional study was conducted using data from the Weekly Report of Obstetrics and Gynaecology Department to assess pregnant women with heart disease characteristics and pregnancy outcomes. A total sample of 69 pregnant women with heart disease regarding their gestational age was included in the study. Variables observed were maternal characteristics, heart disease's clinical parameters, and maternal and neonatal outcomes. Chi-square test was used to examine the different characteristics of congenital and acquired heart disease groups.Results: The prevalence of cardiac disease in pregnancy was 5.19%. Fifty-three point six percent of pregnant women with heart disease were suffered from congenital heart disease (CHD), while 46.4% were acquired heart disease (AHD). Most labor methods were Cesarean delivery, and 69.6% of women experienced cardiac complications. Maternal death was reported in 8.69% of cases. Four cases were CHD complicated by pulmonary hypertension, which leads to Eisenmenger syndrome. Two other cases were AHD complicated by Peripartum Cardiomyopathies. Although statistically insignificant, complications are more common in the AHD group than CHD.Conclusion: Cardiac disease prevalence in pregnancy is considered high, with CHD as the most common case, which significantly differs from other developing countries.

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