PMID- 33130467
OWN - NLM
STAT- MEDLINE
DCOM- 20201217
LR  - 20231019
IS  - 1872-8464 (Electronic)
IS  - 0165-5876 (Print)
IS  - 0165-5876 (Linking)
VI  - 139
DP  - 2020 Dec
TI  - Airway emergency management in a pediatric hospital before and during the 
      COVID-19 pandemic.
PG  - 110458
LID - S0165-5876(20)30601-7 [pii]
LID - 10.1016/j.ijporl.2020.110458 [doi]
AB  - OBJECTIVE: Children's hospitals frequently care for infants with various 
      life-threatening airway anomalies. Management of these infants can be challenging 
      given unique airway anatomy and potential malformations. Airway emergency 
      management must be immediate and precise, often demanding specialized equipment 
      and/or expertise. We developed a Neonatal-Infant Emergency Airway Program to 
      improve medical responses, communication, equipment usage and outcomes for all 
      infants requiring emergent airway interventions in our neonatal and infant 
      intensive care unit (NICU). PATIENTS AND METHODS: All patients admitted to our 
      quaternary NICU from 2008 to 2019 were included in this study. Our program 
      consisted of a multidisciplinary airway response team, pager system, and 
      emergency equipment cart. Respiratory therapists present at each emergency event 
      recorded specialist response times, equipment utilization, and outcomes. A 
      multidisciplinary oversite committee reviewed each incident. RESULTS: Since 2008, 
      there were 159 airway emergency events in our NICU (~12 per year). Mean 
      specialist response times decreased from 5.9 +/- 4.9 min (2008-2012, mean +/- SD) to 
      4.3 +/- 2.2 min (2016-2019, p = 0.12), and the number of incidents with response 
      times >5 min decreased from 28.8 +/- 17.8% (2008-2012) to 9.3 +/- 11.4% (2016-2019, 
      p = 0.04 by linear regression). As our program became more standardized, we noted 
      better equipment availability and subspecialist communication. Few emergency 
      situations (n = 9, 6%) required operating room management. There were 3 patient 
      deaths (2%). CONCLUSIONS: Our airway safety program, including readily available 
      specialists and equipment, facilitated effective resolution of airway emergencies 
      in our NICU and multidisciplinary involvement enabled rapid and effective changes 
      in response to COVID-19 regulations. A similar program could be implemented in 
      other centers.
CI  - Copyright (c) 2020 Elsevier B.V. All rights reserved.
FAU - Thom, Christopher S
AU  - Thom CS
AD  - Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, 
      USA; Division of Neonatology, Perelman School of Medicine at the University of 
      Pennsylvania, Philadelphia, PA, USA.
FAU - Deshmukh, Hitesh
AU  - Deshmukh H
AD  - Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, 
      OH, USA.
FAU - Soorikian, Leane
AU  - Soorikian L
AD  - Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, 
      USA.
FAU - Jacobs, Ian
AU  - Jacobs I
AD  - Division of Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, 
      PA, USA.
FAU - Fiadjoe, John E
AU  - Fiadjoe JE
AD  - Department of Anesthesiology and Critical Care, Children's Hospital of 
      Philadelphia, Perelman School of Medicine, University of Pennsylvania, 
      Philadelphia, PA, USA; Department of Anesthesiology and Critical Care Medicine, 
      Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 
      USA.
FAU - Lioy, Janet
AU  - Lioy J
AD  - Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, 
      USA; Division of Neonatology, Perelman School of Medicine at the University of 
      Pennsylvania, Philadelphia, PA, USA. Electronic address: lioy@chop.edu.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20201017
PL  - Ireland
TA  - Int J Pediatr Otorhinolaryngol
JT  - International journal of pediatric otorhinolaryngology
JID - 8003603
SB  - IM
UOF - medRxiv. 2020 Sep 27;:. PMID: 32995823
MH  - Airway Management/*methods
MH  - COVID-19/epidemiology/*prevention & control
MH  - Emergencies
MH  - Emergency Service, Hospital/*organization & administration
MH  - Female
MH  - Hospitals, Pediatric/*organization & administration
MH  - Humans
MH  - Infant, Newborn
MH  - Infection Control/methods/*organization & administration
MH  - Intensive Care Units, Neonatal/*organization & administration
MH  - Intensive Care, Neonatal/methods/*organization & administration
MH  - Male
MH  - Outcome and Process Assessment, Health Care
MH  - Pandemics
MH  - Patient Care Team/organization & administration
MH  - Patient Safety
MH  - Philadelphia/epidemiology
PMC - PMC7568466
OTO - NOTNLM
OT  - Emergencies
OT  - Infant
OT  - Intubation
OT  - Neonatology
OT  - Pediatrics
COIS- The authors have no relevant conflicts of interest to disclose.
EDAT- 2020/11/02 06:00
MHDA- 2020/12/18 06:00
PMCR- 2020/10/17
CRDT- 2020/11/01 20:38
PHST- 2020/09/29 00:00 [received]
PHST- 2020/10/13 00:00 [revised]
PHST- 2020/10/13 00:00 [accepted]
PHST- 2020/11/02 06:00 [pubmed]
PHST- 2020/12/18 06:00 [medline]
PHST- 2020/11/01 20:38 [entrez]
PHST- 2020/10/17 00:00 [pmc-release]
AID - S0165-5876(20)30601-7 [pii]
AID - 110458 [pii]
AID - 10.1016/j.ijporl.2020.110458 [doi]
PST - ppublish
SO  - Int J Pediatr Otorhinolaryngol. 2020 Dec;139:110458. doi: 
      10.1016/j.ijporl.2020.110458. Epub 2020 Oct 17.