End-Tidal Carbon Dioxide Use for Tracheal Intubation

Analysis from the National Emergency Airway Registry for Children (NEAR4KIDS) Registry

Melissa L. Langhan, Beth L. Emerson, Sholeen Nett, Matthew Pinto, Ilana Harwayne-Gidansky, Kyle J. Rehder, Conrad Krawiec, Keith Meyer, John S. Giuliano, Erin B. Owen, Keiko M. Tarquinio, Ron C. Sanders, Michael Shepherd, Gokul Kris Bysani, Asha N. Shenoi, Natalie Napolitano, Sandeep Gangadharan, Simon J. Parsons, Dennis W. Simon, Vinay M. Nadkarni & 1 others Akira Nishisaki

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: Waveform capnography use has been incorporated into guidelines for the confirmation of tracheal intubation. We aim to describe the trend in waveform capnography use in emergency departments and PICUs and assess the association between waveform capnography use and adverse tracheal intubation-associated events. Design: A multicenter retrospective cohort study. Setting: Thirty-four hospitals (34 ICUs and nine emergency departments) in the National Emergency Airway Registry for Children quality improvement initiative. Patients: Primary tracheal intubation in children younger than 18 years. Interventions: None. Measurements and Main Results: Patient, provider, and practice data for tracheal intubation procedure including a type of end-tidal carbon dioxide measurement, as well as the procedural safety outcomes, were prospectively collected. The use of waveform capnography versus colorimetry was evaluated in association with esophageal intubation with delayed recognition, cardiac arrest, and oxygen desaturation less than 80%. During January 2011 and December 2015, 9,639 tracheal intubations were reported. Waveform capnography use increased over time (39% in 2010 to 53% in 2015; p < 0.001), whereas colorimetry use decreased (< 0.001). There was significant variability in waveform capnography use across institutions (median 49%; interquartile range, 25-85%; p < 0.001). Capnography was used more often in emergency departments as compared with ICUs (66% vs. 49%; p < 0.001). The rate of esophageal intubation with delayed recognition was similar with waveform capnography versus colorimetry (0.39% vs. 0.46%; p = 0.62). The rate of cardiac arrest was also similar (p = 0.49). Oxygen desaturation occurred less frequently when capnography was used (17% vs. 19%; p = 0.03); however, this was not significant after adjusting for patient and provider characteristics. Conclusions: Significant variations existed in capnography use across institutions, with the use increasing over time in both emergency departments and ICUs. The use of capnography during intubation was not associated with esophageal intubation with delayed recognition or the occurrence of cardiac arrest.

Original languageEnglish (US)
Pages (from-to)98-105
Number of pages8
JournalPediatric Critical Care Medicine
Volume19
Issue number2
DOIs
StatePublished - Feb 1 2018

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Capnography
Intubation
Carbon Dioxide
Registries
Emergencies
Colorimetry
Hospital Emergency Service
Heart Arrest
Oxygen
Quality Improvement

All Science Journal Classification (ASJC) codes

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

Cite this

Langhan, Melissa L. ; Emerson, Beth L. ; Nett, Sholeen ; Pinto, Matthew ; Harwayne-Gidansky, Ilana ; Rehder, Kyle J. ; Krawiec, Conrad ; Meyer, Keith ; Giuliano, John S. ; Owen, Erin B. ; Tarquinio, Keiko M. ; Sanders, Ron C. ; Shepherd, Michael ; Bysani, Gokul Kris ; Shenoi, Asha N. ; Napolitano, Natalie ; Gangadharan, Sandeep ; Parsons, Simon J. ; Simon, Dennis W. ; Nadkarni, Vinay M. ; Nishisaki, Akira. / End-Tidal Carbon Dioxide Use for Tracheal Intubation : Analysis from the National Emergency Airway Registry for Children (NEAR4KIDS) Registry. In: Pediatric Critical Care Medicine. 2018 ; Vol. 19, No. 2. pp. 98-105.
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abstract = "Objective: Waveform capnography use has been incorporated into guidelines for the confirmation of tracheal intubation. We aim to describe the trend in waveform capnography use in emergency departments and PICUs and assess the association between waveform capnography use and adverse tracheal intubation-associated events. Design: A multicenter retrospective cohort study. Setting: Thirty-four hospitals (34 ICUs and nine emergency departments) in the National Emergency Airway Registry for Children quality improvement initiative. Patients: Primary tracheal intubation in children younger than 18 years. Interventions: None. Measurements and Main Results: Patient, provider, and practice data for tracheal intubation procedure including a type of end-tidal carbon dioxide measurement, as well as the procedural safety outcomes, were prospectively collected. The use of waveform capnography versus colorimetry was evaluated in association with esophageal intubation with delayed recognition, cardiac arrest, and oxygen desaturation less than 80{\%}. During January 2011 and December 2015, 9,639 tracheal intubations were reported. Waveform capnography use increased over time (39{\%} in 2010 to 53{\%} in 2015; p < 0.001), whereas colorimetry use decreased (< 0.001). There was significant variability in waveform capnography use across institutions (median 49{\%}; interquartile range, 25-85{\%}; p < 0.001). Capnography was used more often in emergency departments as compared with ICUs (66{\%} vs. 49{\%}; p < 0.001). The rate of esophageal intubation with delayed recognition was similar with waveform capnography versus colorimetry (0.39{\%} vs. 0.46{\%}; p = 0.62). The rate of cardiac arrest was also similar (p = 0.49). Oxygen desaturation occurred less frequently when capnography was used (17{\%} vs. 19{\%}; p = 0.03); however, this was not significant after adjusting for patient and provider characteristics. Conclusions: Significant variations existed in capnography use across institutions, with the use increasing over time in both emergency departments and ICUs. The use of capnography during intubation was not associated with esophageal intubation with delayed recognition or the occurrence of cardiac arrest.",
author = "Langhan, {Melissa L.} and Emerson, {Beth L.} and Sholeen Nett and Matthew Pinto and Ilana Harwayne-Gidansky and Rehder, {Kyle J.} and Conrad Krawiec and Keith Meyer and Giuliano, {John S.} and Owen, {Erin B.} and Tarquinio, {Keiko M.} and Sanders, {Ron C.} and Michael Shepherd and Bysani, {Gokul Kris} and Shenoi, {Asha N.} and Natalie Napolitano and Sandeep Gangadharan and Parsons, {Simon J.} and Simon, {Dennis W.} and Nadkarni, {Vinay M.} and Akira Nishisaki",
year = "2018",
month = "2",
day = "1",
doi = "10.1097/PCC.0000000000001372",
language = "English (US)",
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pages = "98--105",
journal = "Pediatric Critical Care Medicine",
issn = "1529-7535",
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}

Langhan, ML, Emerson, BL, Nett, S, Pinto, M, Harwayne-Gidansky, I, Rehder, KJ, Krawiec, C, Meyer, K, Giuliano, JS, Owen, EB, Tarquinio, KM, Sanders, RC, Shepherd, M, Bysani, GK, Shenoi, AN, Napolitano, N, Gangadharan, S, Parsons, SJ, Simon, DW, Nadkarni, VM & Nishisaki, A 2018, 'End-Tidal Carbon Dioxide Use for Tracheal Intubation: Analysis from the National Emergency Airway Registry for Children (NEAR4KIDS) Registry', Pediatric Critical Care Medicine, vol. 19, no. 2, pp. 98-105. https://doi.org/10.1097/PCC.0000000000001372

End-Tidal Carbon Dioxide Use for Tracheal Intubation : Analysis from the National Emergency Airway Registry for Children (NEAR4KIDS) Registry. / Langhan, Melissa L.; Emerson, Beth L.; Nett, Sholeen; Pinto, Matthew; Harwayne-Gidansky, Ilana; Rehder, Kyle J.; Krawiec, Conrad; Meyer, Keith; Giuliano, John S.; Owen, Erin B.; Tarquinio, Keiko M.; Sanders, Ron C.; Shepherd, Michael; Bysani, Gokul Kris; Shenoi, Asha N.; Napolitano, Natalie; Gangadharan, Sandeep; Parsons, Simon J.; Simon, Dennis W.; Nadkarni, Vinay M.; Nishisaki, Akira.

In: Pediatric Critical Care Medicine, Vol. 19, No. 2, 01.02.2018, p. 98-105.

Research output: Contribution to journalArticle

TY - JOUR

T1 - End-Tidal Carbon Dioxide Use for Tracheal Intubation

T2 - Analysis from the National Emergency Airway Registry for Children (NEAR4KIDS) Registry

AU - Langhan, Melissa L.

AU - Emerson, Beth L.

AU - Nett, Sholeen

AU - Pinto, Matthew

AU - Harwayne-Gidansky, Ilana

AU - Rehder, Kyle J.

AU - Krawiec, Conrad

AU - Meyer, Keith

AU - Giuliano, John S.

AU - Owen, Erin B.

AU - Tarquinio, Keiko M.

AU - Sanders, Ron C.

AU - Shepherd, Michael

AU - Bysani, Gokul Kris

AU - Shenoi, Asha N.

AU - Napolitano, Natalie

AU - Gangadharan, Sandeep

AU - Parsons, Simon J.

AU - Simon, Dennis W.

AU - Nadkarni, Vinay M.

AU - Nishisaki, Akira

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objective: Waveform capnography use has been incorporated into guidelines for the confirmation of tracheal intubation. We aim to describe the trend in waveform capnography use in emergency departments and PICUs and assess the association between waveform capnography use and adverse tracheal intubation-associated events. Design: A multicenter retrospective cohort study. Setting: Thirty-four hospitals (34 ICUs and nine emergency departments) in the National Emergency Airway Registry for Children quality improvement initiative. Patients: Primary tracheal intubation in children younger than 18 years. Interventions: None. Measurements and Main Results: Patient, provider, and practice data for tracheal intubation procedure including a type of end-tidal carbon dioxide measurement, as well as the procedural safety outcomes, were prospectively collected. The use of waveform capnography versus colorimetry was evaluated in association with esophageal intubation with delayed recognition, cardiac arrest, and oxygen desaturation less than 80%. During January 2011 and December 2015, 9,639 tracheal intubations were reported. Waveform capnography use increased over time (39% in 2010 to 53% in 2015; p < 0.001), whereas colorimetry use decreased (< 0.001). There was significant variability in waveform capnography use across institutions (median 49%; interquartile range, 25-85%; p < 0.001). Capnography was used more often in emergency departments as compared with ICUs (66% vs. 49%; p < 0.001). The rate of esophageal intubation with delayed recognition was similar with waveform capnography versus colorimetry (0.39% vs. 0.46%; p = 0.62). The rate of cardiac arrest was also similar (p = 0.49). Oxygen desaturation occurred less frequently when capnography was used (17% vs. 19%; p = 0.03); however, this was not significant after adjusting for patient and provider characteristics. Conclusions: Significant variations existed in capnography use across institutions, with the use increasing over time in both emergency departments and ICUs. The use of capnography during intubation was not associated with esophageal intubation with delayed recognition or the occurrence of cardiac arrest.

AB - Objective: Waveform capnography use has been incorporated into guidelines for the confirmation of tracheal intubation. We aim to describe the trend in waveform capnography use in emergency departments and PICUs and assess the association between waveform capnography use and adverse tracheal intubation-associated events. Design: A multicenter retrospective cohort study. Setting: Thirty-four hospitals (34 ICUs and nine emergency departments) in the National Emergency Airway Registry for Children quality improvement initiative. Patients: Primary tracheal intubation in children younger than 18 years. Interventions: None. Measurements and Main Results: Patient, provider, and practice data for tracheal intubation procedure including a type of end-tidal carbon dioxide measurement, as well as the procedural safety outcomes, were prospectively collected. The use of waveform capnography versus colorimetry was evaluated in association with esophageal intubation with delayed recognition, cardiac arrest, and oxygen desaturation less than 80%. During January 2011 and December 2015, 9,639 tracheal intubations were reported. Waveform capnography use increased over time (39% in 2010 to 53% in 2015; p < 0.001), whereas colorimetry use decreased (< 0.001). There was significant variability in waveform capnography use across institutions (median 49%; interquartile range, 25-85%; p < 0.001). Capnography was used more often in emergency departments as compared with ICUs (66% vs. 49%; p < 0.001). The rate of esophageal intubation with delayed recognition was similar with waveform capnography versus colorimetry (0.39% vs. 0.46%; p = 0.62). The rate of cardiac arrest was also similar (p = 0.49). Oxygen desaturation occurred less frequently when capnography was used (17% vs. 19%; p = 0.03); however, this was not significant after adjusting for patient and provider characteristics. Conclusions: Significant variations existed in capnography use across institutions, with the use increasing over time in both emergency departments and ICUs. The use of capnography during intubation was not associated with esophageal intubation with delayed recognition or the occurrence of cardiac arrest.

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