Family Presence During Pediatric Tracheal Intubations
Authors: Ronald C. Sanders, Sholeen T. Nett, Katherine Finn Davis, Margaret M. Parker, G. Kris Bysani, Michelle Adu-Darko, Geoffrey L. Bird, Ira M. Cheifetz, Ashley T. Derbyshire, Guillaume Emeriaud, John S. Giuliano, Ana Lia Graciano, Yusuke Hagiwara, Glenda Hefley, Takanari Ikeyama, J. Dean Jarvis, Pradip Kamat, Ashwin S. Krishna, Anthony Lee, Jan Hau Lee, Simon Li, Keith Meyer, Vicki L. Montgomery, Yuki Nagai, Matthew Pinto, Kyle J. Rehder, Osamu Saito, Asha N. Shenoi, Hester Christianne Taekema, Keiko M. Tarquinio, Ann E. Thompson, David A. Turner, Vinay M. Nadkarni, Akira Nishisaki
Journal: JAMA Pediatrics (2016)

<h3>Importance</h3> 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. <h3>Objective</h3> 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. <h3>Design, Setting, and Participants</h3> 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. <h3>Exposures</h3> Family presence and no FP during TI in the PICU. <h3>Main Outcomes and Measures</h3> 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 &lt;80%), and self-reported team stress level. <h3>Results</h3> 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%;<i>P</i> &lt; .001). Tracheal intubations with FP (vs without FP) were associated with older patients (median, 2 years vs 1 year;<i>P</i> = .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 &lt;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. <h3>Conclusions and Relevance</h3> Wide variability exists in FP during TIs across PICUs. Family presence was not associated with first attempt success, adverse TI-associated events, oxygen desaturation (&lt;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.