Current Medication Practice and Tracheal Intubation Safety Outcomes From a Prospective Multicenter Observational Cohort Study

Keiko M. Tarquinio, Joy D. Howell, Vicki Montgomery, David A. Turner, Deyin D. Hsing, Margaret M. Parker, Calvin A. Brown, Ron M. Walls, Vinay M. Nadkarni, Akira Nishisaki, Michelle Adu-Darko, Michael Apkon, Katherine Biagas, Kris G. Bysani, Ira M. Cheifetz, Kathleen Culver, Ashley Derbyshire, Guillaume Emeriaud, John S. Giuliano, Ana Lia Graciano & 19 others Glenda Hefley, J. Dean Jarvis, Pradip Kamat, Anthony Lee, Simon Li, Keith Meyer, Tracey Monjure, Natalie Napolitano, Sholeen Nett, Gabrielle Nuthall, Matthew Pinto, Kyle J. Rehder, Jackie Rubottom, Ronald Sanders, Michael Shepard, Darlene Simas, Debra Spear, Janice E. Sullivan, Robert Tamburro

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objectives: Tracheal intubation in PICUs is often associated with adverse tracheal intubation-associated events. There is a paucity of data regarding medication selection for safe tracheal intubations in PICUs. Our primary objective was to evaluate the association of medication selection on specific tracheal intubation-associated events across PICUs. Design: Prospective observational cohort study. Setting: Nineteen PICUs in North America. Subjects: Critically ill children requiring tracheal intubation. Interventions: None. Measurement and Main Results: Using the National Emergency Airway Registry for Children, tracheal intubation quality improvement data were prospectively collected from July 2010 to March 2013. Patient, provider, and practice characteristics including medications and dosages were collected. Adverse tracheal intubation-associated events were defined a priori. A total of 3,366 primary tracheal intubations were reported. Adverse tracheal intubation-associated events occurred in 593 tracheal intubations (18%). Fentanyl and midazolam were the most commonly used induction medications (64% and 58%, respectively). Neuromuscular blockade was used in 92% of tracheal intubation with the majority using rocuronium (64%) followed by vecuronium (20%). Etomidate and succinylcholine were rarely used (1.6% and 0.7%, respectively). Vagolytics were administered in 37% of tracheal intubations (51% in infants; 28% in > 1 yr old; p < 0.001). Ketamine was used in 27% of tracheal intubations but more often for tracheal intubations in patients with unstable hemodynamics (39% vs 25%; p < 0.001). However, ketamine use was not associated with lower prevalence of new hypotension (ketamine 8% vs no ketamine 14%; p = 0.08). Conclusions: In this large, pediatric multicenter registry, fentanyl, midazolam, and ketamine were the most commonly used induction agents, and the majority of tracheal intubations involved neuromuscular blockade. Ketamine use was not associated with lower prevalence of hypotension.

Original languageEnglish (US)
Pages (from-to)210-218
Number of pages9
JournalPediatric Critical Care Medicine
Volume16
Issue number3
DOIs
StatePublished - Mar 20 2015

Fingerprint

Intubation
Observational Studies
Cohort Studies
Safety
Ketamine
Neuromuscular Blockade
Midazolam
Fentanyl
Hypotension
Registries
Etomidate
Vecuronium Bromide
Succinylcholine
North America
Quality Improvement
Critical Illness
Emergencies
Hemodynamics

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Tarquinio, K. M., Howell, J. D., Montgomery, V., Turner, D. A., Hsing, D. D., Parker, M. M., ... Tamburro, R. (2015). Current Medication Practice and Tracheal Intubation Safety Outcomes From a Prospective Multicenter Observational Cohort Study. Pediatric Critical Care Medicine, 16(3), 210-218. https://doi.org/10.1097/PCC.0000000000000319
Tarquinio, Keiko M. ; Howell, Joy D. ; Montgomery, Vicki ; Turner, David A. ; Hsing, Deyin D. ; Parker, Margaret M. ; Brown, Calvin A. ; Walls, Ron M. ; Nadkarni, Vinay M. ; Nishisaki, Akira ; Adu-Darko, Michelle ; Apkon, Michael ; Biagas, Katherine ; Bysani, Kris G. ; Cheifetz, Ira M. ; Culver, Kathleen ; Derbyshire, Ashley ; Emeriaud, Guillaume ; Giuliano, John S. ; Graciano, Ana Lia ; Hefley, Glenda ; Jarvis, J. Dean ; Kamat, Pradip ; Lee, Anthony ; Li, Simon ; Meyer, Keith ; Monjure, Tracey ; Napolitano, Natalie ; Nett, Sholeen ; Nuthall, Gabrielle ; Pinto, Matthew ; Rehder, Kyle J. ; Rubottom, Jackie ; Sanders, Ronald ; Shepard, Michael ; Simas, Darlene ; Spear, Debra ; Sullivan, Janice E. ; Tamburro, Robert. / Current Medication Practice and Tracheal Intubation Safety Outcomes From a Prospective Multicenter Observational Cohort Study. In: Pediatric Critical Care Medicine. 2015 ; Vol. 16, No. 3. pp. 210-218.
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abstract = "Objectives: Tracheal intubation in PICUs is often associated with adverse tracheal intubation-associated events. There is a paucity of data regarding medication selection for safe tracheal intubations in PICUs. Our primary objective was to evaluate the association of medication selection on specific tracheal intubation-associated events across PICUs. Design: Prospective observational cohort study. Setting: Nineteen PICUs in North America. Subjects: Critically ill children requiring tracheal intubation. Interventions: None. Measurement and Main Results: Using the National Emergency Airway Registry for Children, tracheal intubation quality improvement data were prospectively collected from July 2010 to March 2013. Patient, provider, and practice characteristics including medications and dosages were collected. Adverse tracheal intubation-associated events were defined a priori. A total of 3,366 primary tracheal intubations were reported. Adverse tracheal intubation-associated events occurred in 593 tracheal intubations (18{\%}). Fentanyl and midazolam were the most commonly used induction medications (64{\%} and 58{\%}, respectively). Neuromuscular blockade was used in 92{\%} of tracheal intubation with the majority using rocuronium (64{\%}) followed by vecuronium (20{\%}). Etomidate and succinylcholine were rarely used (1.6{\%} and 0.7{\%}, respectively). Vagolytics were administered in 37{\%} of tracheal intubations (51{\%} in infants; 28{\%} in > 1 yr old; p < 0.001). Ketamine was used in 27{\%} of tracheal intubations but more often for tracheal intubations in patients with unstable hemodynamics (39{\%} vs 25{\%}; p < 0.001). However, ketamine use was not associated with lower prevalence of new hypotension (ketamine 8{\%} vs no ketamine 14{\%}; p = 0.08). Conclusions: In this large, pediatric multicenter registry, fentanyl, midazolam, and ketamine were the most commonly used induction agents, and the majority of tracheal intubations involved neuromuscular blockade. Ketamine use was not associated with lower prevalence of hypotension.",
author = "Tarquinio, {Keiko M.} and Howell, {Joy D.} and Vicki Montgomery and Turner, {David A.} and Hsing, {Deyin D.} and Parker, {Margaret M.} and Brown, {Calvin A.} and Walls, {Ron M.} and Nadkarni, {Vinay M.} and Akira Nishisaki and Michelle Adu-Darko and Michael Apkon and Katherine Biagas and Bysani, {Kris G.} and Cheifetz, {Ira M.} and Kathleen Culver and Ashley Derbyshire and Guillaume Emeriaud and Giuliano, {John S.} and Graciano, {Ana Lia} and Glenda Hefley and Jarvis, {J. Dean} and Pradip Kamat and Anthony Lee and Simon Li and Keith Meyer and Tracey Monjure and Natalie Napolitano and Sholeen Nett and Gabrielle Nuthall and Matthew Pinto and Rehder, {Kyle J.} and Jackie Rubottom and Ronald Sanders and Michael Shepard and Darlene Simas and Debra Spear and Sullivan, {Janice E.} and Robert Tamburro",
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Tarquinio, KM, Howell, JD, Montgomery, V, Turner, DA, Hsing, DD, Parker, MM, Brown, CA, Walls, RM, Nadkarni, VM, Nishisaki, A, Adu-Darko, M, Apkon, M, Biagas, K, Bysani, KG, Cheifetz, IM, Culver, K, Derbyshire, A, Emeriaud, G, Giuliano, JS, Graciano, AL, Hefley, G, Jarvis, JD, Kamat, P, Lee, A, Li, S, Meyer, K, Monjure, T, Napolitano, N, Nett, S, Nuthall, G, Pinto, M, Rehder, KJ, Rubottom, J, Sanders, R, Shepard, M, Simas, D, Spear, D, Sullivan, JE & Tamburro, R 2015, 'Current Medication Practice and Tracheal Intubation Safety Outcomes From a Prospective Multicenter Observational Cohort Study', Pediatric Critical Care Medicine, vol. 16, no. 3, pp. 210-218. https://doi.org/10.1097/PCC.0000000000000319

Current Medication Practice and Tracheal Intubation Safety Outcomes From a Prospective Multicenter Observational Cohort Study. / Tarquinio, Keiko M.; Howell, Joy D.; Montgomery, Vicki; Turner, David A.; Hsing, Deyin D.; Parker, Margaret M.; Brown, Calvin A.; Walls, Ron M.; Nadkarni, Vinay M.; Nishisaki, Akira; Adu-Darko, Michelle; Apkon, Michael; Biagas, Katherine; Bysani, Kris G.; Cheifetz, Ira M.; Culver, Kathleen; Derbyshire, Ashley; Emeriaud, Guillaume; Giuliano, John S.; Graciano, Ana Lia; Hefley, Glenda; Jarvis, J. Dean; Kamat, Pradip; Lee, Anthony; Li, Simon; Meyer, Keith; Monjure, Tracey; Napolitano, Natalie; Nett, Sholeen; Nuthall, Gabrielle; Pinto, Matthew; Rehder, Kyle J.; Rubottom, Jackie; Sanders, Ronald; Shepard, Michael; Simas, Darlene; Spear, Debra; Sullivan, Janice E.; Tamburro, Robert.

In: Pediatric Critical Care Medicine, Vol. 16, No. 3, 20.03.2015, p. 210-218.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Current Medication Practice and Tracheal Intubation Safety Outcomes From a Prospective Multicenter Observational Cohort Study

AU - Tarquinio, Keiko M.

AU - Howell, Joy D.

AU - Montgomery, Vicki

AU - Turner, David A.

AU - Hsing, Deyin D.

AU - Parker, Margaret M.

AU - Brown, Calvin A.

AU - Walls, Ron M.

AU - Nadkarni, Vinay M.

AU - Nishisaki, Akira

AU - Adu-Darko, Michelle

AU - Apkon, Michael

AU - Biagas, Katherine

AU - Bysani, Kris G.

AU - Cheifetz, Ira M.

AU - Culver, Kathleen

AU - Derbyshire, Ashley

AU - Emeriaud, Guillaume

AU - Giuliano, John S.

AU - Graciano, Ana Lia

AU - Hefley, Glenda

AU - Jarvis, J. Dean

AU - Kamat, Pradip

AU - Lee, Anthony

AU - Li, Simon

AU - Meyer, Keith

AU - Monjure, Tracey

AU - Napolitano, Natalie

AU - Nett, Sholeen

AU - Nuthall, Gabrielle

AU - Pinto, Matthew

AU - Rehder, Kyle J.

AU - Rubottom, Jackie

AU - Sanders, Ronald

AU - Shepard, Michael

AU - Simas, Darlene

AU - Spear, Debra

AU - Sullivan, Janice E.

AU - Tamburro, Robert

PY - 2015/3/20

Y1 - 2015/3/20

N2 - Objectives: Tracheal intubation in PICUs is often associated with adverse tracheal intubation-associated events. There is a paucity of data regarding medication selection for safe tracheal intubations in PICUs. Our primary objective was to evaluate the association of medication selection on specific tracheal intubation-associated events across PICUs. Design: Prospective observational cohort study. Setting: Nineteen PICUs in North America. Subjects: Critically ill children requiring tracheal intubation. Interventions: None. Measurement and Main Results: Using the National Emergency Airway Registry for Children, tracheal intubation quality improvement data were prospectively collected from July 2010 to March 2013. Patient, provider, and practice characteristics including medications and dosages were collected. Adverse tracheal intubation-associated events were defined a priori. A total of 3,366 primary tracheal intubations were reported. Adverse tracheal intubation-associated events occurred in 593 tracheal intubations (18%). Fentanyl and midazolam were the most commonly used induction medications (64% and 58%, respectively). Neuromuscular blockade was used in 92% of tracheal intubation with the majority using rocuronium (64%) followed by vecuronium (20%). Etomidate and succinylcholine were rarely used (1.6% and 0.7%, respectively). Vagolytics were administered in 37% of tracheal intubations (51% in infants; 28% in > 1 yr old; p < 0.001). Ketamine was used in 27% of tracheal intubations but more often for tracheal intubations in patients with unstable hemodynamics (39% vs 25%; p < 0.001). However, ketamine use was not associated with lower prevalence of new hypotension (ketamine 8% vs no ketamine 14%; p = 0.08). Conclusions: In this large, pediatric multicenter registry, fentanyl, midazolam, and ketamine were the most commonly used induction agents, and the majority of tracheal intubations involved neuromuscular blockade. Ketamine use was not associated with lower prevalence of hypotension.

AB - Objectives: Tracheal intubation in PICUs is often associated with adverse tracheal intubation-associated events. There is a paucity of data regarding medication selection for safe tracheal intubations in PICUs. Our primary objective was to evaluate the association of medication selection on specific tracheal intubation-associated events across PICUs. Design: Prospective observational cohort study. Setting: Nineteen PICUs in North America. Subjects: Critically ill children requiring tracheal intubation. Interventions: None. Measurement and Main Results: Using the National Emergency Airway Registry for Children, tracheal intubation quality improvement data were prospectively collected from July 2010 to March 2013. Patient, provider, and practice characteristics including medications and dosages were collected. Adverse tracheal intubation-associated events were defined a priori. A total of 3,366 primary tracheal intubations were reported. Adverse tracheal intubation-associated events occurred in 593 tracheal intubations (18%). Fentanyl and midazolam were the most commonly used induction medications (64% and 58%, respectively). Neuromuscular blockade was used in 92% of tracheal intubation with the majority using rocuronium (64%) followed by vecuronium (20%). Etomidate and succinylcholine were rarely used (1.6% and 0.7%, respectively). Vagolytics were administered in 37% of tracheal intubations (51% in infants; 28% in > 1 yr old; p < 0.001). Ketamine was used in 27% of tracheal intubations but more often for tracheal intubations in patients with unstable hemodynamics (39% vs 25%; p < 0.001). However, ketamine use was not associated with lower prevalence of new hypotension (ketamine 8% vs no ketamine 14%; p = 0.08). Conclusions: In this large, pediatric multicenter registry, fentanyl, midazolam, and ketamine were the most commonly used induction agents, and the majority of tracheal intubations involved neuromuscular blockade. Ketamine use was not associated with lower prevalence of hypotension.

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