• Danielle M Van Damme, Emily M McRae, Sharon Y Irving, Serena P Kelly, Keiko M Tarquinio, John S Giuliano, Michael D Ruppe, Krista L Kierys, Ryan K Breuer, Simon J Parsons, Palen P Mallory, Asha N Shenoi, Kelly A Swain, Lee A Polikoff, Anthony Lee, Michelle A Adu-Darko, Natalie Napolitano, Justine Shults, Akira Nishisaki, John W Berkenbosch, and National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI).
• "Just For Kids" Critical Care Center, Norton Children's Hospital, Louisville, KY.
• Pediatr Crit Care Me. 2024 Feb 1; 25 (2): 139146139-146.

ObjectivesTo describe tracheal intubation (TI) practice by Advanced Practice Registered Nurses (APRNs) in North American PICUs, including rates of TI-associated events (TIAEs) from 2015 to 2019.Design/SettingRetrospective study using the National Emergency Airway Registry for Children with all TIs performed in PICU and pediatric cardiac ICU between January 2015 and December 2019. The primary outcome was first attempt TI success rate. Secondary outcomes were TIAEs, severe TIAEs, and hypoxemia.SubjectsCritically ill children requiring TI in a PICU or pediatric cardiac ICU.InterventionsNone.Measurements And Main ResultsAmong 11,012 TIs, APRNs performed 1,626 (14.7%). Overall, TI by APRNs, compared with other clinicians, occurred less frequently in patients with known difficult airway (11.1% vs. 14.3%; p < 0.001), but more frequently in infants younger than 1 year old (55.9% vs. 44.4%; p < 0.0001), and in patients with cardiac disease (26.3% vs. 15.9%; p < 0.0001).There was lower odds of success in first attempt TI for APRNs vs. other clinicians (adjusted odds ratio, 0.70; 95% CI, 0.62-0.79). We failed to identify a difference in rates of TIAE, severe TIAE, and oxygen desaturation events for TIs by APRNs compared with other clinicians. The TI first attempt success rate improved with APRN experience (< 1 yr: 54.2%, 1-5 yr: 59.4%, 6-10 yr: 67.6%, > 10 yr: 63.1%; p = 0.021).ConclusionsTI performed by APRNs was associated with lower odds of first attempt success when compared with other ICU clinicians although there was no appreciable difference in procedural adverse events. There appears to be a positive relationship between experience and success rates. These data suggest there is an ongoing need for opportunities to build on TI competency with APRNs.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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