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Accepted (AM)Open Access (License Unspecified), Open
Journal article
Assessment of Nonroutine Events During Intubation After Pediatric Trauma
The Journal of surgical research, v 259, pp 276-283
Mar 2021
PMID: 33138986
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Intubation in the early postinjury phase can be a high-risk procedure associated with an increased risk of mortality when delayed. Nonroutine events (NREs) are workflow disruptions that can be latent safety threats in high-risk settings and may contribute to adverse outcomes.
We reviewed videos of intubations of injured children (age<17 y old) in the emergency department occurring between 2014 and 2018 to identify NREs occurring between the decision to intubate and successful intubation (“critical window”).
Among 34 children requiring intubation, the indications included GCS≤8 (n = 20, 58.8%), cardiac arrest (n = 6, 17.6%), airway protection (n = 5, 14.7%), and respiratory failure (n = 3, 8.8%). The median duration of the “critical window” was 7.5 min (range 1.4-27.5 min), with a median of six NREs per case in this period (range 2-30). Most NREs (n = 159, 61.9%) delayed workflow, with 31 (12.1%) of these delays each lasting more than one minute. Eighty-seven NREs (33.9%) had a potential for harm but did not lead to direct patient harm. The most common NREs directly related to the intubation process were poor positioning for intubation (n = 23, 8.9%) and difficulty passing the endotracheal tube (n = 5, 1.9%), with most being attributed to the anesthesiologist performing the intubation (n = 51, range 0-7).
Workflow disruptions related to nonroutine events were frequent during pediatric trauma intubation and were often associated with delays and potential for patient harm. Interventions for improving the efficiency and timeliness of the critical window should focus on adherence to intubation protocol and improving communication and teamwork related to tasks in this phase.
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Details
- Title
- Assessment of Nonroutine Events During Intubation After Pediatric Trauma
- Creators
- Emily C Alberto - Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, District of ColumbiaMichael J Amberson - Department of Pediatrics, Children’s National Hospital, Washington, District of ColumbiaMegan Cheng - Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, District of ColumbiaIvan Marsic - Department of Electrical and Computer Engineering, Rutgers University, Piscataway, New JerseyArunachalam A Thenappan - Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, District of ColumbiaAleksandra Sarcevic - College of Computing and Informatics, Drexel University, Philadelphia, PennsylvaniaKaren J O'Connell - Division of Emergency Medicine, Children’s National Hospital, Washington, District of ColumbiaRandall S Burd - Division of Trauma and Burn Surgery, Children’s National Hospital, Washington, District of Columbia
- Publication Details
- The Journal of surgical research, v 259, pp 276-283
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Information Science
- Web of Science ID
- WOS:000620267800035
- Scopus ID
- 2-s2.0-85094857540
- Other Identifier
- 991014976889604721
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InCites Highlights
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Surgery