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Research ArticleOriginal Research

Improvement of Pediatric Advanced Airway Management in General Emergency Departments After a Collaborative Intervention Program

Manahil Mustafa, Riad Lutfi, Hani Alsaedi, Peter Castelluccio, Kellie J Pearson, Erin E Montgomery, Mara E Nitu, Kamal Abulebda and Samer Abu-Sultaneh
Respiratory Care December 2021, 66 (12) 1866-1875; DOI: https://doi.org/10.4187/respcare.09250
Manahil Mustafa
Pediatrics, Hurley Medical Center and Michigan State University, Flint, Michigan.
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Riad Lutfi
Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.
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Hani Alsaedi
Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.
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Peter Castelluccio
Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
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Kellie J Pearson
LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana.
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Erin E Montgomery
LifeLine Critical Care Transport, Indiana University Health, Indianapolis, Indiana.
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Mara E Nitu
Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.
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Kamal Abulebda
Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.
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Samer Abu-Sultaneh
Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, Indiana.
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Abstract

BACKGROUND: In general emergency departments, advanced airway management of pediatric patients who are critically ill has been associated with increased adverse events given the varying exposure to pediatric patients and limited resources. Previous studies have shown significant improvement of simulated pediatric airway management in general emergency departments. The aim of this retrospective study was to determine the effect of an in situ simulation-based collaborative intervention program on the actual care of pediatric airway management in general emergency departments.

METHODS: This was a retrospective study of pediatric subjects who were critically ill and required intubation at a diverse set of general emergency departments before referral to the academic medical center. The primary outcome was the quality of clinical care measured by adherence to best practices via a critical action checklist. Secondary outcomes included tracheal intubation associated adverse events and clinical outcomes.

RESULTS: A total of 135 pediatric subjects (48 pre- and 87 post-intervention) who were transferred to the academic medical center from 9 general emergency departments between May 2014 and August 2019 were included in the analysis. The use of a cuffed endotracheal tube improved, from 44% to 72% (P = .001), whereas there was no significant change in the appropriate endotracheal tube size. Overall, severe tracheal intubation associated adverse events decreased, from 18.8% to 9.2% (P = .03), and post-intubation cardiac arrest events decreased, from 6.3% to 0% (P = .02).

CONCLUSIONS: A simulation-based collaborative intervention program led to improvement in pediatric airway management and subject outcomes in general emergency departments. This model demonstrated the transfer of improvement from a simulated setting to a clinical setting and may be targeted in other clinical settings.

  • airway management
  • intubation
  • in situ simulation
  • academic medical center
  • general emergency department

Footnotes

  • Correspondence: Samer Abu-Sultaneh MD, Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana. E-mail: sultaneh{at}iu.edu
  • The project was funded by an Indiana University Health Values grant (VFE-332 [Dr Lutfi], VFE-342 [Dr Abu-Sultaneh]).

  • The authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (12)
Respiratory Care
Vol. 66, Issue 12
1 Dec 2021
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Improvement of Pediatric Advanced Airway Management in General Emergency Departments After a Collaborative Intervention Program
Manahil Mustafa, Riad Lutfi, Hani Alsaedi, Peter Castelluccio, Kellie J Pearson, Erin E Montgomery, Mara E Nitu, Kamal Abulebda, Samer Abu-Sultaneh
Respiratory Care Dec 2021, 66 (12) 1866-1875; DOI: 10.4187/respcare.09250

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Improvement of Pediatric Advanced Airway Management in General Emergency Departments After a Collaborative Intervention Program
Manahil Mustafa, Riad Lutfi, Hani Alsaedi, Peter Castelluccio, Kellie J Pearson, Erin E Montgomery, Mara E Nitu, Kamal Abulebda, Samer Abu-Sultaneh
Respiratory Care Dec 2021, 66 (12) 1866-1875; DOI: 10.4187/respcare.09250
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Keywords

  • airway management
  • intubation
  • in situ simulation
  • academic medical center
  • general emergency department

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