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Pediatr Crit Care Med. 2018 Feb;19(2):98-105. doi: 10.1097/PCC.0000000000001372.

End-Tidal Carbon Dioxide Use for Tracheal Intubation: Analysis From the National Emergency Airway Registry for Children (NEAR4KIDS) Registry.

Author information

1
Section of Pediatric Emergency Medicine, Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT.
2
Section of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
3
Department of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY.
4
Pediatric Critical Care Medicine, Stony Brook Children's Hospital, Stony Brook, NY.
5
Division of Critical Care, Department of Pediatrics, Duke Children's Hospital, Durham, NC.
6
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine, Hershey, PA.
7
Division of Critical Care Medicine, Department of Pediatrics, Nicklaus Children's Hospital, Miami Children's Health System, Miami, FL.
8
Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
9
Division of Critical Care Medicine, Department of Pediatrics, Norton Children's Hospital, Louisville, KY.
10
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA.
11
Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Science College of Medicine, Arkansas Children's Hospital, Little Rock, AR.
12
Paediatric Emergency Medicine, Starship Children's Hospital, New Zealand.
13
Department of Pediatric Critical Care Medicine, Medical City Children's Hospital, Dallas, TX.
14
Division of Critical Care Medicine, Department of Pediatrics, Kentucky Children's Hospital, Lexington, KY.
15
Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA.
16
Department of Pediatrics, Cohen Children's Medical Center, Northwell Health System, Hofstra School of Medicine, Hempstead, NY.
17
Department of Critical Care, Alberta Children's Hospital, Calgary, AB, Canada.
18
Department of Pediatric Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
19
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.

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.

PMID:
29140968
DOI:
10.1097/PCC.0000000000001372
[Indexed for MEDLINE]

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