Timing of tracheal intubation on mortality and duration of mechanical ventilation in critically ill children: A propensity score analysis. Issue 11 (20th August 2020)

• Record Type: Journal Article
• Authors: Chong, Shu‐Ling; Dang, Trung Kien; Loh, Tsee Foong; Mok, Yee Hui; Bin Mohamed Atan, Mohamed Shirhan; Montanez, Eugene; Lee, Jan Hau; Feng, Mengling
• Is Part Of: Pediatric pulmonology. Volume 55:Issue 11(2020)
• Page Start: 3126
• Page End: 3133
• Publication Date: 2020-08-20
• Subjects: intensive care -- mechanical ventilation -- mortality -- pediatric -- resuscitation -- tracheal intubation; Pediatric respiratory diseases -- Periodicals; Pediatrics -- Periodicals; 618.922
• DOI: 10.1002/ppul.25026
• Languages: English
• ISSNs: 8755-6863

Abstract

Abstract: Objective: We aimed to investigate whether early tracheal intubation (TI) is associated with a reduced risk of mortality and increased ventilator‐free days (VFD). Methods: We performed a retrospective cohort study of children 0 to 18 years old in a pediatric intensive care unit (PICU), between 2008 and 2017. Patient demographics, vital signs, and laboratory findings were extracted. Using a time‐dependent propensity score‐matched algorithm, each patient was matched with another equally likely to be intubated within the same hour but was actually intubated with ≤2 hours, 2 to 4 hours, and 4 to 6 hours delays. Outcomes were mortality and VFD. Results: Among 333 patients, the median age was 1.72 years (interquartile range [IQR] 0.17‐7.75). Thirty children died (9.0%) and the median PICU length of stay was 6.7 days (IQR 3.9‐13.2). Early TI did not decrease mortality significantly when compared to a ≤2 hour delay (odds ratios [OR] 0.86; 95% CI, 0.40‐1.85), a 2 to 4 hour delay (OR, 0.81; 95% CI, 0.39‐1.69), or a 4 to 6 hour delay (OR, 0.87; 95% CI, 0.43‐1.79). Similarly, early TI did not significantly increase VFD. Patients with early TI had 0.09 more VFD (95% CI −1.83 to 2.01) when compared to a delay within 2 hours, 0.23 more VFD (95% CI −1.66 to 2.13) when compared to a 2 to 4‐hour delay and 0.56 more VFD (95% CI −1.49‐2.61) when compared to a 4 to 6‐hour delay. Conclusions: We did not find a significant association between the timing of TI and mortality or VFD in critically ill children.