Tracheal Intubation by Advanced Practice Registered Nurses in Pediatric Critical Care: Retrospective Study From the National Emergency Airway for Children Registry (2015-2019)

OBJECTIVES

To describe tracheal intubation (TI) practice by Advanced Practice Registered Nurses (APRNs) in North American PICUs, including rates of TI-associated events (TIAEs) from 2015 to 2019.

DESIGN/SETTING

Retrospective study using the National Emergency Airway Registry for Children with all TIs performed in PICU and pediatric cardiac ICU between January 2015 and December 2019. The primary outcome was first attempt TI success rate. Secondary outcomes were TIAEs, severe TIAEs, and hypoxemia.

SUBJECTS

Critically ill children requiring TI in a PICU or pediatric cardiac ICU.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Among 11,012 TIs, APRNs performed 1,626 (14.7%). Overall, TI by APRNs, compared with other clinicians, occurred less frequently in patients with known difficult airway (11.1% vs. 14.3%; p < 0.001), but more frequently in infants younger than 1 year old (55.9% vs. 44.4%; p < 0.0001), and in patients with cardiac disease (26.3% vs. 15.9%; p < 0.0001).There was lower odds of success in first attempt TI for APRNs vs. other clinicians (adjusted odds ratio, 0.70; 95% CI, 0.62-0.79). We failed to identify a difference in rates of TIAE, severe TIAE, and oxygen desaturation events for TIs by APRNs compared with other clinicians. The TI first attempt success rate improved with APRN experience (< 1 yr: 54.2%, 1-5 yr: 59.4%, 6-10 yr: 67.6%, > 10 yr: 63.1%; p = 0.021).

CONCLUSIONS

TI performed by APRNs was associated with lower odds of first attempt success when compared with other ICU clinicians although there was no appreciable difference in procedural adverse events. There appears to be a positive relationship between experience and success rates. These data suggest there is an ongoing need for opportunities to build on TI competency with APRNs.

Duration of detection of fecal excretion of Escherichia coli O157:H7 in cattle

To better define the bovine reservoir of Escherichia coli O157:H7, cattle were tested monthly by bacteriologic culture for fecal excretion of E. coli. E. coli O157:H7 was isolated from feces of 56 cattle sampled an average of 6.98 times (2-12 samples). By broth enrichment culture, immunomagnetic separation, or both, 35 cattle had 1 positive sample, 12 had 2, 7 had 3, and 1 each had 4 and 5. Five cattle with > or = 2 positive samples were in a herd in which 5 pulsed-field gel electrophoretic (PFGE) types were simultaneously present; in 3 of these cattle, different PFGE types were detected in different samples. The duration of detected excretion E. coli O157:H7 by individual cattle in this study was <1 month in 35 (63%) of 56 cattle. Both serial and concurrent excretion of different E. coli O157:H7 strains by individual cattle was observed.