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Timing of tracheal intubation on mortality and duration of mechanical ventilation in critically ill children: A propensity score analysis
Author(s) -
Chong ShuLing,
Dang Trung Kien,
Loh Tsee Foong,
Mok Yee Hui,
Bin Mohamed Atan Mohamed Shirhan,
Montanez Eugene,
Lee Jan Hau,
Feng Mengling
Publication year - 2020
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25026
Subject(s) - medicine , interquartile range , intubation , mechanical ventilation , anesthesia , odds ratio , propensity score matching , retrospective cohort study , tracheal intubation , intensive care unit , pediatric intensive care unit , cohort , pediatrics , surgery
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.