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Difficult Bag-Mask Ventilation in Critically Ill Children Is Independently Associated With Adverse Events.

Abstract：

OBJECTIVES:Bag-mask ventilation is commonly used prior to tracheal intubation; however, the epidemiology, risk factors, and clinical implications of difficult bag-mask ventilation among critically ill children are not well studied. This study aims to describe prevalence and risk factors for pediatric difficult bag-mask ventilation as well as its association with adverse tracheal intubation-associated events and oxygen desaturation in PICU patients. DESIGN:A retrospective review of prospectively collected observational data from a multicenter tracheal intubation database (National Emergency Airway Registry for Children) from January 2013 to December 2018. SETTING:Forty-six international PICUs. PATIENTS:Children receiving bag-mask ventilation as a part of tracheal intubation in a PICU. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:The primary outcome is the occurrence of either specific tracheal intubation-associated events (hemodynamic tracheal intubation-associated events, emesis with/without aspiration) and/or oxygen desaturation (< 80%). Factors associated with perceived difficult bag-mask ventilation were found using univariate analyses, and multivariable logistic regression identified an independent association between bag-mask ventilation difficulty and the primary outcome. Difficult bag-mask ventilation is reported in 9.5% (n = 1,501) of 15,810 patients undergoing tracheal intubation with bag-mask ventilation during the study period. Difficult bag-mask ventilation is more commonly reported with increasing age, those with a primary respiratory diagnosis/indication for tracheal intubation, presence of difficult airway features, more experienced provider level, and tracheal intubations without use of neuromuscular blockade (p < 0.001). Specific tracheal intubation-associated events or oxygen desaturation events occurred in 40.2% of patients with reported difficult bag-mask ventilation versus 19.8% in patients without perceived difficult bag-mask ventilation (p < 0.001). The presence of difficult bag-mask ventilation is independently associated with an increased risk of the primary outcome: odds ratio, 2.28 (95% CI, 2.03-2.57; p < 0.001). CONCLUSIONS:Difficult bag-mask ventilation is reported in approximately one in 10 PICU patients undergoing tracheal intubation. Given its association with adverse procedure-related events and oxygen desaturation, future study is warranted to improve preprocedural planning and real-time management strategies.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Daigle CH,Fiadjoe JE,Laverriere EK,Bruins BB,Lockman JL,Shults J,Krawiec C,Harwayne-Gidansky I,Page-Goertz C,Furlong-Dillard J,Nadkarni VM,Nishisaki A,National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and

doi

10.1097/CCM.0000000000004425

subject

Has Abstract

pub_date

2020-09-01 00:00:00

pages

e744-e752

issue

eissn

0090-3493

issn

1530-0293

journal_volume

pub_type

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Difficult Bag-Mask Ventilation in Critically Ill Children Is Independently Associated With Adverse Events.