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A Study of Practice Behavior for Endotracheal Intubation Site for Children With Congenital Heart Disease Undergoing Surgery: Impact of Endotracheal Intubation Site on Perioperative Outcomes-An Analysis of the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society Database.

dc.contributor.author Greene, Nathaniel
dc.contributor.author Wang, Alice
dc.contributor.author Jooste, Edmund H
dc.contributor.author Thibault, Dylan P
dc.contributor.author Wallace, Amelia S
dc.contributor.author Vener, David F
dc.contributor.author Matsouaka, Roland A
dc.contributor.author Jacobs, Marshall L
dc.contributor.author Jacobs, Jeffrey P
dc.contributor.author Hill, Kevin D
dc.contributor.author Ames, Warwick A
dc.date.accessioned 2018-10-01T13:16:36Z
dc.date.available 2018-10-01T13:16:36Z
dc.date.issued 2018-09-05
dc.identifier.issn 0003-2999
dc.identifier.issn 1526-7598
dc.identifier.uri https://hdl.handle.net/10161/17542
dc.description.abstract In adults undergoing cardiopulmonary bypass surgery, oral intubation is typically preferred over nasal intubation due to reduced risk of sinusitis and infection. In children, nasal intubation is more common and sometimes preferred due to perceived benefits of less postoperative sedation and a lower risk for accidental extubation. This study sought to describe the practice of nasal intubation in the pediatric population undergoing cardiopulmonary bypass surgery and assess the risks/benefits of a nasal route against an oral one.Patients <18 years of age in the Society of Thoracic Surgeons Congenital Heart Surgery Database between January 2010 and December 2015 were included. Patients with a preoperative endotracheal tube, tracheostomy, or known airway anomalies were excluded. Multivariable modeling was used to assess the association between route of tracheal intubation and a composite measure of infection risk (wound infection, mediastinitis, septicemia, pneumonia, and endocarditis). Covariates were included to adjust for important patient characteristics (eg, weight, age, comorbidities), case complexity, and center effects. Secondary outcomes included length of intubation, hospital length of stay, and airway complications including accidental extubations. We also performed a subanalysis in children <12 months of age in high-volume centers (>100 cases/y) examining how infection risk may change with age at the time of surgery.Nasal intubation was used in 41% of operations in neonates, 38% in infants, 15% in school-aged children, and 2% in adolescents. Nasal intubation appeared protective for accidental extubation only in neonates (P = .02). Multivariable analysis in infants and neonates showed that the nasal route of intubation was not associated with the infection composite (relative risk [RR], 0.84; 95% CI, 0.59-1.18) or a shorter length of stay (RR, 0.992; 95% CI, 0.947-1.039), but was associated with a shorter intubation length (RR, 0.929; 95% CI, 0.869-0.992). Restricting to high-volume centers showed a significant interaction between age and intubation route with a risk change for infection occurring between approximately 6-12 months of age (P = .003).While older children undergoing nasal intubation trend similar to the adult population with an increased risk of infection, nasal intubation in neonates and infants does not appear to carry a similar risk. Nasal intubation in neonates and infants may also be associated with a shorter intubation length but not a shorter length of stay. Prospective studies are required to better understand these complex associations.
dc.language eng
dc.relation.ispartof Anesthesia and analgesia
dc.relation.isversionof 10.1213/ane.0000000000003594
dc.title A Study of Practice Behavior for Endotracheal Intubation Site for Children With Congenital Heart Disease Undergoing Surgery: Impact of Endotracheal Intubation Site on Perioperative Outcomes-An Analysis of the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society Database.
dc.type Journal article
dc.date.updated 2018-10-01T13:16:35Z
pubs.organisational-group Staff
pubs.organisational-group Duke
pubs.organisational-group Surgery
pubs.organisational-group Clinical Science Departments
pubs.organisational-group School of Medicine
pubs.organisational-group Anesthesiology, Pediatrics
pubs.organisational-group Anesthesiology
pubs.publication-status Published
duke.contributor.orcid Greene, Nathaniel|0000-0003-0230-0499


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