AHRQ Study: Benefits of Family Presence During Pediatric Intubation Often Outweigh Risks

The benefits of having a family member present during invasive pediatric procedures far outweigh the risks, which include a potential increase in stress for clinicians and family members, according to an AHRQ-funded study. The study examined whether the presence of a family member during tracheal intubation was associated with a successful first attempt at the procedure, adverse events associated with tracheal intubation, oxygen desaturation and higher team stress levels. Researchers reviewed data from 22 pediatric intensive care units between July 2010 and March 2014, which included 4,030 tracheal intubations, to evaluate the association of family presence and procedure and provider outcomes. They found no significant negative effect of documented family presence on provider performance, team stress or patient outcomes during the procedures. These findings suggested that tracheal intubation can safely be implemented with a child’s family present as part of a family-centered care model. Read the abstract of the article, “Family Presence During Pediatric Tracheal Intubations,” published in the journal JAMA Pediatrics.

2016 Mar 7;170(3):e154627. doi: 10.1001/jamapediatrics.2015.4627. Epub 2016 Mar 7.

Family Presence During Pediatric Tracheal Intubations.

Sanders RC Jr1, Nett ST2, Davis KF3, Parker MM4, Bysani GK5, Adu-Darko M6, Bird GL7, Cheifetz IM8, Derbyshire AT9, Emeriaud G10, Giuliano JS Jr11,Graciano AL12, Hagiwara Y13, Hefley G1, Ikeyama T13, Jarvis JD2, Kamat P14, Krishna AS15, Lee A16, Lee JH17, Li S18, Meyer K19, Montgomery VL20, Nagai Y13, Pinto M18, Rehder KJ8, Saito O13, Shenoi AN15, Taekema HC21, Tarquinio KM22, Thompson AE23, Turner DA8, Nadkarni VM24, Nishisaki A24; National Emergency Airway Registry for Children (NEAR4KIDS) Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.

Author information

Abstract

IMPORTANCE:

Family-centered care, which supports family presence (FP) during procedures, is now a widely accepted standard at health care facilities that care for children. However, there is a paucity of data regarding the practice of FP during tracheal intubation (TI) in pediatric intensive care units (PICUs). Family presence during procedures in PICUs has been advocated.

OBJECTIVE:

To describe the current practice of FP during TI and evaluate the association with procedural and clinician (including physician, respiratory therapist, and nurse practitioner) outcomes across multiple PICUs.

DESIGN, SETTING, AND PARTICIPANTS:

Prospective cohort study in which all TIs from July 2010 to March 2014 in the multicenter TI database (National Emergency Airway Registry for Children [NEAR4KIDS]) were analyzed. Family presence was defined as a family member present during TI. This study included all TIs in patients younger than 18 years in 22 international PICUs.

EXPOSURES:

Family presence and no FP during TI in the PICU.

MAIN OUTCOMES AND MEASURES:

The percentage of FP during TIs. First attempt success rate, adverse TI-associated events, multiple attempts (≥3), oxygen desaturation (oxygen saturation as measured by pulse oximetry <80%), and self-reported team stress level.

RESULTS:

A total of 4969 TI encounters were reported. Among those, 81% (n = 4030) of TIs had documented FP status (with/without). The median age of participants with FP was 2 years and 1 year for those without FP. The average percentage of TIs with FP was 19% and varied widely across sites (0%-43%; P < .001). Tracheal intubations with FP (vs without FP) were associated with older patients (median, 2 years vs 1 year; P = .04), lower Paediatric Index of Mortality 2 score, and pediatric resident as the first airway clinician (23%, n = 179 vs 18%, n = 584; odds ratio [OR], 1.4; 95% CI, 1.2-1.7). Tracheal intubations with FP and without FP were no different in the first attempt success rate (OR, 1.00; 95% CI, 0.85-1.18), adverse TI-associated events (any events: OR, 1.06; 95% CI, 0.85-1.30 and severe events: OR, 1.04; 95% CI, 0.75-1.43), multiple attempts (≥3) (OR, 1.03; 95% CI, 0.82-1.28), oxygen desaturation (oxygen saturation <80%) (OR, 0.97; 95% CI, 0.80-1.18), or self-reported team stress level (OR, 1.09; 95% CI, 0.92-1.31). This result persisted after adjusting for patient and clinician confounders.

CONCLUSIONS AND RELEVANCE:

Wide variability exists in FP during TIs across PICUs. Family presence was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (<80%), or higher team stress level. Our data suggest that FP during TI can safely be implemented as part of a family-centered care model in the PICU.