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John F. Jennings, Division of Pediatric Critical Care, Department of Pediatrics, Cohen Children’s Medical Center
Sholeen Nett, Division of Pediatric Critical Care, Department of Pediatrics, Dartmouth Hitchcock Medical Center
Rachel Umoren, Division of Neonatology, Department of Pediatrics, University of Washington
Robert Murray, Division of Critical Care, Department of Pediatrics, Nationwide Children’s Hospital
Aaron Kessel, Division of Pediatric Critical Care, Department of Pediatrics, Cohen Children’s Medical Center
Natalie Napolitano, Department of Respiratory Care, The Children’s Hospital of Philadelphia
Michelle Adu-Darko, Department of Pediatric Critical Care, University of Virginia Children's Hospital
Katherine Biagas, Department of Pediatric Critical Care Medicine, The Renaissance School of Medicine at Stony Brook University
Philipp Jung, Department of Pediatrics, University Hospital Schleswig-Holstein, Campus Luebeck, Germany
Debra Spear, Department of Pediatric Critical Care, Penn State Health, Penn State Hershey Medical Center
Simon Parsons, Division of Critical Care, Alberta Children's Hospital
Ryan Breuer, Division of Pediatric Critical Care, Department of Pediatric Critical Care Medicine, University of Buffalo, Oishei Children's Hospital
Keith Meyer, Division of Critical Care Medicine, Nicklaus Children's Hospital/Herbert Wertheim College of Medicine Florida International University
Matthew Malone, Department of Pediatrics, Division of Critical Care Medicine, The University of Arkansas for Medical Sciences/Arkansas Children's Hospital
Asha Shenoi, Department of Pediatrics, Heinrich A. Werner Division of Pediatric Critical Care Medicine, University of Kentucky School of Medicine
Anthony Lee, Division of Critical Care Medicine, Nationwide Children's Hospital
Palen Mallory, Department of Pediatrics, Duke University
Awni Al-Subu, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health
Keiko Tarquinio, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Emory University School of Medicine, Children's Healthcare of Atlanta
Lily Glater, Division of Pediatric Critical Care, Department of Pediatrics, Steven & Alexandra Cohen Children’s Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell
Megan Toal, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine
Jan Hau Lee, Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
Matthew Pinto, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College
Lee Polikoff, Division of Pediatric Critical Care Medicine, The Warren Alpert School of Medicine at Brown University
Erin Own, Department of Pediatric Critical Care Medicine, University of Louisville and Norton Children's Hospital
Iris Toedt-Pingel, Department of Pediatrics, University of Vermont Children's Hospital
Mioko Kasagi, Department of Pediatric Critical & Emergency Care Medicine, Tokyo Metropolitan Children's Hospital, Japan
Laurence Ducharme-Crevier, Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal. Montréal, Québec, Canada
Makoto Motomura, Division of Pediatric Critical Care Medicine, Aichi Children's Health and Medical Center, Aichi, Japan
Masafumi Gima, Department of Critical Care Medicine, National Center for Child Health and Development, Japan
Serena Kelly, Department of Pediatrics, Pediatric Critical Care, OHSU, Doernbecher Children’s Hospital
Josep Panisello, Section of Pediatric Critical Care Medicine, Department Of Pediatrics, Yale University Medical School
Gabrielle Nuthall, Department of Pediatric Critical Care, Starship Children's Hospital, New Zealand
Kelsey Gladen, Division of Pediatric Critical Care, Department of Pediatrics, Phoenix Children’s Hospital
Justine Shults, Division of Biostatistics, Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine
Vinay Nadkarni, Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia; Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine
Akira Nishisaki, Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia; Department of Anesthesiology, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of MedicineFollow

Abstract

Background: Tracheal intubation in critically ill children is a life-saving, but high-risk procedure that involves multiple team members with diverse clinical skills. We aim to examine the association between the provider-reported teamwork rating and the occurrence of adverse tracheal intubation–associated events (TIAEs). Methods: A retrospective analysis of prospectively collected data from 45 pediatric intensive care units (PICUs) in the National Emergency Airway Registry for Children (NEAR4KIDS) database from January 2013 to March 2018 was performed. A composite teamwork score was generated using the average of each of five (7-point Likert scale) domains in the teamwork assessment tool. Poor teamwork was defined as an average score of 4 or lower. Team provider stress data were also recorded with each intubation. Results: 12,536 tracheal intubations (TIs) were reported from 2013 to 2018. Approximately 4.1% (n=520) rated a poor teamwork score. TIs indicated for shock were more commonly associated with a poor teamwork score, while those indicated for procedures and those utilizing neuromuscular blockade were less commonly associated with a poor teamwork score. TIs with poor teamwork were associated with a higher occurrence of adverse TIAE (24.4% vs. 14.4%, p<0.001), severe TIAE (13.7% vs. 5.9%, p<0.001), and peri-intubation hypoxemia < 80% (26.4% vs. 17.9%, p<0.001). After adjusting for indication, provider type, and neuromuscular blockade use, poor teamwork was associated with higher odds of adverse TIAEs (OR 1.77, 95% CI 1.35-2.34), severe TIAEs (OR 2.23, 95% CI 1.47-3.37) and hypoxemia (OR 1.63, 95% CI 1.25-2.03). Conclusion: TIs with poor teamwork were independently associated with a higher occurrence of TIAEs, severe TIAEs, and hypoxemia.

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