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1. Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE):a prospective European multicentre observational study

Author

Disma, Nicola, Virag, Katalin, Riva, Thomas, Kaufmann, Jost, Engelhardt, Thomas, Habre, Walid, Breschan, Christian, Likar, Rudolf, Platzer, Manuela, Edelman, Isole, Eger, Johanes, Heschl, Stefan, Messerer, Brigitte, Vittinghof, Maria, Kroess, Ruth, Stichlberger, Martina, Kahn, David, Pirotte, Thierry, Pregardien, Caroline, Veyckemans, Francis, Stevens, France, Berghmans, Johan, Bauters, Annemie, De Baerdemaeker, Luc, De Hert, Stefan, Lapage, Koen, Parashchanka, Aliaksandra, Van Limmen, Jurgen, Wyffels, Piet, Lauweryns, Julie, Najafi, Nadia, Vundelinckx, Joris, Butković, Diana, Sorić, Ivana Kerovec, Kralik, Sandra, Markić, Ana, Azman, Josip, Markic, Josko, Pupacic, Daniela, Frelich, Michal, Reimer, Petr, Urbanec, René, Afshari, Arash, Ellekvist, Marguerite, Disma, Nicola, Virag, Katalin, Riva, Thomas, Kaufmann, Jost, Engelhardt, Thomas, Habre, Walid, Breschan, Christian, Likar, Rudolf, Platzer, Manuela, Edelman, Isole, Eger, Johanes, Heschl, Stefan, Messerer, Brigitte, Vittinghof, Maria, Kroess, Ruth, Stichlberger, Martina, Kahn, David, Pirotte, Thierry, Pregardien, Caroline, Veyckemans, Francis, Stevens, France, Berghmans, Johan, Bauters, Annemie, De Baerdemaeker, Luc, De Hert, Stefan, Lapage, Koen, Parashchanka, Aliaksandra, Van Limmen, Jurgen, Wyffels, Piet, Lauweryns, Julie, Najafi, Nadia, Vundelinckx, Joris, Butković, Diana, Sorić, Ivana Kerovec, Kralik, Sandra, Markić, Ana, Azman, Josip, Markic, Josko, Pupacic, Daniela, Frelich, Michal, Reimer, Petr, Urbanec, René, Afshari, Arash, and Ellekvist, Marguerite

Abstract

Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348.

Published
2021

2. Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE):a prospective European multicentre observational study

Author

Disma, Nicola, Virag, Katalin, Riva, Thomas, Kaufmann, Jost, Engelhardt, Thomas, Habre, Walid, Breschan, Christian, Likar, Rudolf, Platzer, Manuela, Edelman, Isole, Eger, Johanes, Heschl, Stefan, Messerer, Brigitte, Vittinghof, Maria, Kroess, Ruth, Stichlberger, Martina, Kahn, David, Pirotte, Thierry, Pregardien, Caroline, Veyckemans, Francis, Stevens, France, Berghmans, Johan, Bauters, Annemie, De Baerdemaeker, Luc, De Hert, Stefan, Lapage, Koen, Parashchanka, Aliaksandra, Van Limmen, Jurgen, Wyffels, Piet, Lauweryns, Julie, Najafi, Nadia, Vundelinckx, Joris, Butković, Diana, Sorić, Ivana Kerovec, Kralik, Sandra, Markić, Ana, Azman, Josip, Markic, Josko, Pupacic, Daniela, Frelich, Michal, Reimer, Petr, Urbanec, René, Afshari, Arash, Ellekvist, Marguerite, Disma, Nicola, Virag, Katalin, Riva, Thomas, Kaufmann, Jost, Engelhardt, Thomas, Habre, Walid, Breschan, Christian, Likar, Rudolf, Platzer, Manuela, Edelman, Isole, Eger, Johanes, Heschl, Stefan, Messerer, Brigitte, Vittinghof, Maria, Kroess, Ruth, Stichlberger, Martina, Kahn, David, Pirotte, Thierry, Pregardien, Caroline, Veyckemans, Francis, Stevens, France, Berghmans, Johan, Bauters, Annemie, De Baerdemaeker, Luc, De Hert, Stefan, Lapage, Koen, Parashchanka, Aliaksandra, Van Limmen, Jurgen, Wyffels, Piet, Lauweryns, Julie, Najafi, Nadia, Vundelinckx, Joris, Butković, Diana, Sorić, Ivana Kerovec, Kralik, Sandra, Markić, Ana, Azman, Josip, Markic, Josko, Pupacic, Daniela, Frelich, Michal, Reimer, Petr, Urbanec, René, Afshari, Arash, and Ellekvist, Marguerite

Abstract

Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348.

Published
2021

3. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Author

Habre, Walid, Disma, Nicola, Virag, Katalin, Becke, Karin, Hansen, Tom G., Joehr, Martin, Leva, Brigitte, Morton, Neil S., Vermeulen, Petronella M., Zielinska, Marzena, Boda, Krisztina, Veyckemans, Francis, Klimscha, Walter, Konecny, Regina, Luntzer, Robert, Morawk-Wintersperger, Ulrike, Neiger, Franz, Rustemeyer, Lydia, Breschan, Christian, Frey, Denise, Platzer, Manuela, Germann, Reinhard, Oeding, Joachim, Stoegermuller, Birgit, Ziegler, Bernhard, Brotatsch, Philipp, Gutmann, Anton, Mausser, Gerlinde, Messerer, Brigitte, Toller, Wolfgang, Vittinghoff, Maria, Zangl, Gregor, Seidel-Ahyai, Natascha, Hochhold, Christoph, Kroess, Ruth, Paal, Peter, Cnudde, Steven, Coucke, Patricia, Loveniers, Birgit, Mitchell, John, Kahn, David, Pirotte, Thierry, Pregardien, Caroline, Coppens, Marc, De Baerdemaeker, Luc, De Hert, Stefan, Heyse, Bjorn, Neckebroek, Martine, Parashchanka, Aliaksandra, Van Limmen, Jurgen, Van Den Eynde, Nancy, Vanpeteghem, Caroline, Wyffels, Piet, Lalot, Michael, Lechat, Jean-Paul, Stevens, France, Casaer, Sari, De Groote, Francoise, De Pooter, Francoise, De Ville, Andree, Gerin, Marc, Magasich, Natalia, Torres, Cristel Sanchez, Van Deenen, Denise, Berghmans, Johan, Himpe, Dirk, Roofthooft, Eva, Joukes, Ellen, Smitz, Carine, Van Reeth, Veronique, Huygens, Christel, Lauweryns, Julie, De Smet, Karen, Najafi, Nadia, Poelaert, Jan, Van de Velde, Anne, Van Mossevelde, Veerle, Bekavac, Ivan, Butkovic, Diana, Litvic, Dubravka Heli, Soric, Ivana Kerovec, Maretic, Hrvoje, Moscatello, Djurdjica, Popovic, Ljiljana, Micic, Slobodan, Tus, Ivana Stuck, Fabris, Lada Kalagac, Simurina, Tatjana, Sulen, Nina, Kesi-Valpotic, Gordana, Djapic, Dajana, Zurek, Jiri, Jureckova, Lucie, Mackova, Iveta, Skacel, Monika, Weinlichova, Stanislava, Divak, Jan, Frelich, Michal, Urbanec, Rene, Biskupova, Vera, Mixa, Vladimir, Pavlickova, Jana, Afshari, Arash, Bottger, Morten, Ellekvist, Marguerite B., Johansen, Mathias, Madsen, Birgitte Ingeborg, Nilsson, Jens Christian, Schousboe, Birgitte M. B., Clausen, Nicola G., Steen, Nick Phaff, Ilmoja, Mari-Liis, Tonise, Virge, Karjagin, Juri, Kikas, Reet, Isohanni, Mika, Lyly, Anniina, Takala, Annika, Happo, Johanna, Kiviluoma, Kai, Martikainen, Kati, Aantaa, Riku, Manner, Tuula, Vilo, Sanna, Amory, Catherine, Ludot, Hugues, Lambotte, Patricia, Busche, Rene, Jacqmarcq, Olivier, Lejus, Corinne, Corouge, Julien, Erb, Christian, Garrigue, Delphine, Gillet, Patricia, Laffargue, Anne, Lambelin, Veronique, Le Freche, Helene, Peresbota, Daliana, Richart, Pierre, Berton, Jerome, Chapotte, Catherine, Colbus, Laurent, Lehousse, Thierry, Monrigal, Jean, Baujard, Catherine, Roulleau, Philippe, Staiti, Giuseppe, Batoz, Helene, Bordes, Maryline, Didier, Anne, Hamonic, Yann, Lagarde, Sylvaine, Nouette-Gaulain, Karine, Semjen, Francois, Zaghet, Brigitte, Dekens, Jacky, Delcuze, Axelle, Dupont, Herve, Legrand, Aurelien, Raffoflandreur, Celine, Audren, Noemie, Camus, Blandine, Cartal, Marielle, Chazelet, Chantal, Davin, Isabelle, Guillier, Marion, Desjeux, Luc, Larcher, Claire, Grein, Elodie, Leclercq, Mickeal, Levitchi, Roxana, Rosu, Lilica, Simon, Dominique, Zang, Aurelien, Migeon, Anne, Gagey, Anne-Charlotte, Bourdaud, Nathalie, Carre, Anne-Charlotte, Duflo, Frederic, Riche, Jean-Claude, Robert, Philippe, Druot, Emilie, Maupain, Olivier, Orliaguet, Gilles, Sabau, Lucie, Taright, Hanna, Uhrig, Lynn, Verchere-Montmayeur, Juliette, Debrabant, Lise, Pilla, Clotaire, Podvin, Alexandre, Roth, Benjamin, Dahmani, Souhayl, Julien-Marsollier, Florence, Sabourdin, Nada, Alexandri, Bogdan, Brezac, Gilles, de la Briere, Francois, Hayem, Catherine, Lhubat, Elizabeth, Mission, Jean Paul, Remond, Charlotte, Dadure, Christophe, Maniora, Maud, Marie, Anais, Pirat, Philippe, Saour, Anne-Charlotte, Sola, Chrystelle, Ecoffey, Claude, Wodey, Eric, Adam, Christian, Standl, Thomas, Schindler, Ehrenfried, Yamamoto, Tomohiro, Brackhahn, Michael, Eich, Christoph Bernhard, Guericke, Holger, Kindermann, Petra, Laschat, Michael, Schink, Cornel, Wappler, Frank, Hoehne, Claudia, Skordou, Natalia, Ulrici, Johanna, Jetzek-Zader, Martin, Kienbaum, Peter, Meyer-Treschan, Tanja, Picker, Olaf, Schaefer, Maximilian S., Mielke, Golo, Baethge, Sabine, Ramminger, Axel, Bauer, Martin, Bollinger, Matthias, Hinz, Jose, Quintel, Michael, Russo, Sebastian G., Bauer, Michael, Geil, Dfominik, Kortgen, Andreas, Preussler, Niels-Peter, Hofmann, Ulrich, Raber, Manfred, Reindl, Doris, Oppenrieder, Karin, Schierlinger, Bettina, Roth, Jens, Funk, Wolfgang, Fischer, Thomas, Gernoth, Christian, Wiefelsputz, Christina, Volger, Hauke, Zederer, Nicole, Diers, Anja, Huber, Matthias, Schorer, Clemens, Weyland, Andreas, Schwarzkopf, Konrad, Grau, Catharina, Roth, Winfried, Holy, Rolf, Mader, Thomas, Peter, Laura, Supthut, Hauke, Kuehhirt, Thomas, Milde, Alexander, Fiedler, Fritz, Isselhorst, Carsten, Grundmann, Ulrich, Pattar, Alexander, Reinert, Jennifer, Ehm, Birgit, Fritzsche, Katrin, Gaebler, Ralf, Meybohm, Patrick, Hein, Maximilian, Guzman, Ines, Jokinen, Johanna, Kranke, Peter, Goebel, Ulrich, Harris, Sarah, Eisner, Christoph, Ochsenreiter, Miriam, Schoeler, Michael, Thil, Elke, Ellerkmann, Richard, Hoeft, Andreas, Neumann, Claudia, Weber, Stefan, Keilhauer, Julia, Kloessing, Jan, Schramm, Michael, Trieschmann, Uwe, Knauss, Kristina, Sinner, Barbara, Steinmann, Johannes, Koessler, Herbert, Kalliardou, Evagelia, Malisiova, Anna, Tsiotou, Adelais, Chloropoulou, Pelagia, Chrysi, Mpratzou, Iordanidou, Despoina, Ntavlis, Merkourios, Rarosi, Ferenc, Boda, Krisztina B., Guerin, Christilynn, Irwin, Janice, Magner, Claire, Nakhjavani, Solmaz, O'Hare, Brendan, Galvin, Deborah, Jamil, Yosry, Lesmes, Carlos, Barak, Yuri, Fisher, Haran, Kachko, Ludmyla, Katz, Jacob, Kirilov, Dmitry, Levinzon, Michael, Manevich, Yair, Nekrasov, Konstantin, Peled, Elia, Sanko, Elena, Schmain, Dmitri, Sheinkin, Olga, Simhi, Eliahu, Tarabikin, Alex, Trabkin, Evelina, Yagudaev, Irena, Zeitlin, Yelena, Zunser, Igor, Habre, Walid, Disma, Nicola, Virag, Katalin, Becke, Karin, Hansen, Tom G., Joehr, Martin, Leva, Brigitte, Morton, Neil S., Vermeulen, Petronella M., Zielinska, Marzena, Boda, Krisztina, Veyckemans, Francis, Klimscha, Walter, Konecny, Regina, Luntzer, Robert, Morawk-Wintersperger, Ulrike, Neiger, Franz, Rustemeyer, Lydia, Breschan, Christian, Frey, Denise, Platzer, Manuela, Germann, Reinhard, Oeding, Joachim, Stoegermuller, Birgit, Ziegler, Bernhard, Brotatsch, Philipp, Gutmann, Anton, Mausser, Gerlinde, Messerer, Brigitte, Toller, Wolfgang, Vittinghoff, Maria, Zangl, Gregor, Seidel-Ahyai, Natascha, Hochhold, Christoph, Kroess, Ruth, Paal, Peter, Cnudde, Steven, Coucke, Patricia, Loveniers, Birgit, Mitchell, John, Kahn, David, Pirotte, Thierry, Pregardien, Caroline, Coppens, Marc, De Baerdemaeker, Luc, De Hert, Stefan, Heyse, Bjorn, Neckebroek, Martine, Parashchanka, Aliaksandra, Van Limmen, Jurgen, Van Den Eynde, Nancy, Vanpeteghem, Caroline, Wyffels, Piet, Lalot, Michael, Lechat, Jean-Paul, Stevens, France, Casaer, Sari, De Groote, Francoise, De Pooter, Francoise, De Ville, Andree, Gerin, Marc, Magasich, Natalia, Torres, Cristel Sanchez, Van Deenen, Denise, Berghmans, Johan, Himpe, Dirk, Roofthooft, Eva, Joukes, Ellen, Smitz, Carine, Van Reeth, Veronique, Huygens, Christel, Lauweryns, Julie, De Smet, Karen, Najafi, Nadia, Poelaert, Jan, Van de Velde, Anne, Van Mossevelde, Veerle, Bekavac, Ivan, Butkovic, Diana, Litvic, Dubravka Heli, Soric, Ivana Kerovec, Maretic, Hrvoje, Moscatello, Djurdjica, Popovic, Ljiljana, Micic, Slobodan, Tus, Ivana Stuck, Fabris, Lada Kalagac, Simurina, Tatjana, Sulen, Nina, Kesi-Valpotic, Gordana, Djapic, Dajana, Zurek, Jiri, Jureckova, Lucie, Mackova, Iveta, Skacel, Monika, Weinlichova, Stanislava, Divak, Jan, Frelich, Michal, Urbanec, Rene, Biskupova, Vera, Mixa, Vladimir, Pavlickova, Jana, Afshari, Arash, Bottger, Morten, Ellekvist, Marguerite B., Johansen, Mathias, Madsen, Birgitte Ingeborg, Nilsson, Jens Christian, Schousboe, Birgitte M. B., Clausen, Nicola G., Steen, Nick Phaff, Ilmoja, Mari-Liis, Tonise, Virge, Karjagin, Juri, Kikas, Reet, Isohanni, Mika, Lyly, Anniina, Takala, Annika, Happo, Johanna, Kiviluoma, Kai, Martikainen, Kati, Aantaa, Riku, Manner, Tuula, Vilo, Sanna, Amory, Catherine, Ludot, Hugues, Lambotte, Patricia, Busche, Rene, Jacqmarcq, Olivier, Lejus, Corinne, Corouge, Julien, Erb, Christian, Garrigue, Delphine, Gillet, Patricia, Laffargue, Anne, Lambelin, Veronique, Le Freche, Helene, Peresbota, Daliana, Richart, Pierre, Berton, Jerome, Chapotte, Catherine, Colbus, Laurent, Lehousse, Thierry, Monrigal, Jean, Baujard, Catherine, Roulleau, Philippe, Staiti, Giuseppe, Batoz, Helene, Bordes, Maryline, Didier, Anne, Hamonic, Yann, Lagarde, Sylvaine, Nouette-Gaulain, Karine, Semjen, Francois, Zaghet, Brigitte, Dekens, Jacky, Delcuze, Axelle, Dupont, Herve, Legrand, Aurelien, Raffoflandreur, Celine, Audren, Noemie, Camus, Blandine, Cartal, Marielle, Chazelet, Chantal, Davin, Isabelle, Guillier, Marion, Desjeux, Luc, Larcher, Claire, Grein, Elodie, Leclercq, Mickeal, Levitchi, Roxana, Rosu, Lilica, Simon, Dominique, Zang, Aurelien, Migeon, Anne, Gagey, Anne-Charlotte, Bourdaud, Nathalie, Carre, Anne-Charlotte, Duflo, Frederic, Riche, Jean-Claude, Robert, Philippe, Druot, Emilie, Maupain, Olivier, Orliaguet, Gilles, Sabau, Lucie, Taright, Hanna, Uhrig, Lynn, Verchere-Montmayeur, Juliette, Debrabant, Lise, Pilla, Clotaire, Podvin, Alexandre, Roth, Benjamin, Dahmani, Souhayl, Julien-Marsollier, Florence, Sabourdin, Nada, Alexandri, Bogdan, Brezac, Gilles, de la Briere, Francois, Hayem, Catherine, Lhubat, Elizabeth, Mission, Jean Paul, Remond, Charlotte, Dadure, Christophe, Maniora, Maud, Marie, Anais, Pirat, Philippe, Saour, Anne-Charlotte, Sola, Chrystelle, Ecoffey, Claude, Wodey, Eric, Adam, Christian, Standl, Thomas, Schindler, Ehrenfried, Yamamoto, Tomohiro, Brackhahn, Michael, Eich, Christoph Bernhard, Guericke, Holger, Kindermann, Petra, Laschat, Michael, Schink, Cornel, Wappler, Frank, Hoehne, Claudia, Skordou, Natalia, Ulrici, Johanna, Jetzek-Zader, Martin, Kienbaum, Peter, Meyer-Treschan, Tanja, Picker, Olaf, Schaefer, Maximilian S., Mielke, Golo, Baethge, Sabine, Ramminger, Axel, Bauer, Martin, Bollinger, Matthias, Hinz, Jose, Quintel, Michael, Russo, Sebastian G., Bauer, Michael, Geil, Dfominik, Kortgen, Andreas, Preussler, Niels-Peter, Hofmann, Ulrich, Raber, Manfred, Reindl, Doris, Oppenrieder, Karin, Schierlinger, Bettina, Roth, Jens, Funk, Wolfgang, Fischer, Thomas, Gernoth, Christian, Wiefelsputz, Christina, Volger, Hauke, Zederer, Nicole, Diers, Anja, Huber, Matthias, Schorer, Clemens, Weyland, Andreas, Schwarzkopf, Konrad, Grau, Catharina, Roth, Winfried, Holy, Rolf, Mader, Thomas, Peter, Laura, Supthut, Hauke, Kuehhirt, Thomas, Milde, Alexander, Fiedler, Fritz, Isselhorst, Carsten, Grundmann, Ulrich, Pattar, Alexander, Reinert, Jennifer, Ehm, Birgit, Fritzsche, Katrin, Gaebler, Ralf, Meybohm, Patrick, Hein, Maximilian, Guzman, Ines, Jokinen, Johanna, Kranke, Peter, Goebel, Ulrich, Harris, Sarah, Eisner, Christoph, Ochsenreiter, Miriam, Schoeler, Michael, Thil, Elke, Ellerkmann, Richard, Hoeft, Andreas, Neumann, Claudia, Weber, Stefan, Keilhauer, Julia, Kloessing, Jan, Schramm, Michael, Trieschmann, Uwe, Knauss, Kristina, Sinner, Barbara, Steinmann, Johannes, Koessler, Herbert, Kalliardou, Evagelia, Malisiova, Anna, Tsiotou, Adelais, Chloropoulou, Pelagia, Chrysi, Mpratzou, Iordanidou, Despoina, Ntavlis, Merkourios, Rarosi, Ferenc, Boda, Krisztina B., Guerin, Christilynn, Irwin, Janice, Magner, Claire, Nakhjavani, Solmaz, O'Hare, Brendan, Galvin, Deborah, Jamil, Yosry, Lesmes, Carlos, Barak, Yuri, Fisher, Haran, Kachko, Ludmyla, Katz, Jacob, Kirilov, Dmitry, Levinzon, Michael, Manevich, Yair, Nekrasov, Konstantin, Peled, Elia, Sanko, Elena, Schmain, Dmitri, Sheinkin, Olga, Simhi, Eliahu, Tarabikin, Alex, Trabkin, Evelina, Yagudaev, Irena, Zeitlin, Yelena, and Zunser, Igor

Abstract

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for

Published
2017

4. Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

Author

Habre, Walid, Disma, Nicola, Virag, Katalin, Becke, Karin, Hansen, Tom G., Joehr, Martin, Leva, Brigitte, Morton, Neil S., Vermeulen, Petronella M., Zielinska, Marzena, Boda, Krisztina, Veyckemans, Francis, Klimscha, Walter, Konecny, Regina, Luntzer, Robert, Morawk-Wintersperger, Ulrike, Neiger, Franz, Rustemeyer, Lydia, Breschan, Christian, Frey, Denise, Platzer, Manuela, Germann, Reinhard, Oeding, Joachim, Stoegermuller, Birgit, Ziegler, Bernhard, Brotatsch, Philipp, Gutmann, Anton, Mausser, Gerlinde, Messerer, Brigitte, Toller, Wolfgang, Vittinghoff, Maria, Zangl, Gregor, Seidel-Ahyai, Natascha, Hochhold, Christoph, Kroess, Ruth, Paal, Peter, Cnudde, Steven, Coucke, Patricia, Loveniers, Birgit, Mitchell, John, Kahn, David, Pirotte, Thierry, Pregardien, Caroline, Coppens, Marc, De Baerdemaeker, Luc, De Hert, Stefan, Heyse, Bjorn, Neckebroek, Martine, Parashchanka, Aliaksandra, Van Limmen, Jurgen, Van Den Eynde, Nancy, Vanpeteghem, Caroline, Wyffels, Piet, Lalot, Michael, Lechat, Jean-Paul, Stevens, France, Casaer, Sari, De Groote, Francoise, De Pooter, Francoise, De Ville, Andree, Gerin, Marc, Magasich, Natalia, Torres, Cristel Sanchez, Van Deenen, Denise, Berghmans, Johan, Himpe, Dirk, Roofthooft, Eva, Joukes, Ellen, Smitz, Carine, Van Reeth, Veronique, Huygens, Christel, Lauweryns, Julie, De Smet, Karen, Najafi, Nadia, Poelaert, Jan, Van de Velde, Anne, Van Mossevelde, Veerle, Bekavac, Ivan, Butkovic, Diana, Litvic, Dubravka Heli, Soric, Ivana Kerovec, Maretic, Hrvoje, Moscatello, Djurdjica, Popovic, Ljiljana, Micic, Slobodan, Tus, Ivana Stuck, Fabris, Lada Kalagac, Simurina, Tatjana, Sulen, Nina, Kesi-Valpotic, Gordana, Djapic, Dajana, Zurek, Jiri, Jureckova, Lucie, Mackova, Iveta, Skacel, Monika, Weinlichova, Stanislava, Divak, Jan, Frelich, Michal, Urbanec, Rene, Biskupova, Vera, Mixa, Vladimir, Pavlickova, Jana, Afshari, Arash, Bottger, Morten, Ellekvist, Marguerite B., Johansen, Mathias, Madsen, Birgitte Ingeborg, Nilsson, Jens Christian, Schousboe, Birgitte M. B., Clausen, Nicola G., Steen, Nick Phaff, Ilmoja, Mari-Liis, Tonise, Virge, Karjagin, Juri, Kikas, Reet, Isohanni, Mika, Lyly, Anniina, Takala, Annika, Happo, Johanna, Kiviluoma, Kai, Martikainen, Kati, Aantaa, Riku, Manner, Tuula, Vilo, Sanna, Amory, Catherine, Ludot, Hugues, Lambotte, Patricia, Busche, Rene, Jacqmarcq, Olivier, Lejus, Corinne, Corouge, Julien, Erb, Christian, Garrigue, Delphine, Gillet, Patricia, Laffargue, Anne, Lambelin, Veronique, Le Freche, Helene, Peresbota, Daliana, Richart, Pierre, Berton, Jerome, Chapotte, Catherine, Colbus, Laurent, Lehousse, Thierry, Monrigal, Jean, Baujard, Catherine, Roulleau, Philippe, Staiti, Giuseppe, Batoz, Helene, Bordes, Maryline, Didier, Anne, Hamonic, Yann, Lagarde, Sylvaine, Nouette-Gaulain, Karine, Semjen, Francois, Zaghet, Brigitte, Dekens, Jacky, Delcuze, Axelle, Dupont, Herve, Legrand, Aurelien, Raffoflandreur, Celine, Audren, Noemie, Camus, Blandine, Cartal, Marielle, Chazelet, Chantal, Davin, Isabelle, Guillier, Marion, Desjeux, Luc, Larcher, Claire, Grein, Elodie, Leclercq, Mickeal, Levitchi, Roxana, Rosu, Lilica, Simon, Dominique, Zang, Aurelien, Migeon, Anne, Gagey, Anne-Charlotte, Bourdaud, Nathalie, Carre, Anne-Charlotte, Duflo, Frederic, Riche, Jean-Claude, Robert, Philippe, Druot, Emilie, Maupain, Olivier, Orliaguet, Gilles, Sabau, Lucie, Taright, Hanna, Uhrig, Lynn, Verchere-Montmayeur, Juliette, Debrabant, Lise, Pilla, Clotaire, Podvin, Alexandre, Roth, Benjamin, Dahmani, Souhayl, Julien-Marsollier, Florence, Sabourdin, Nada, Alexandri, Bogdan, Brezac, Gilles, de la Briere, Francois, Hayem, Catherine, Lhubat, Elizabeth, Mission, Jean Paul, Remond, Charlotte, Dadure, Christophe, Maniora, Maud, Marie, Anais, Pirat, Philippe, Saour, Anne-Charlotte, Sola, Chrystelle, Ecoffey, Claude, Wodey, Eric, Adam, Christian, Standl, Thomas, Schindler, Ehrenfried, Yamamoto, Tomohiro, Brackhahn, Michael, Eich, Christoph Bernhard, Guericke, Holger, Kindermann, Petra, Laschat, Michael, Schink, Cornel, Wappler, Frank, Hoehne, Claudia, Skordou, Natalia, Ulrici, Johanna, Jetzek-Zader, Martin, Kienbaum, Peter, Meyer-Treschan, Tanja, Picker, Olaf, Schaefer, Maximilian S., Mielke, Golo, Baethge, Sabine, Ramminger, Axel, Bauer, Martin, Bollinger, Matthias, Hinz, Jose, Quintel, Michael, Russo, Sebastian G., Bauer, Michael, Geil, Dfominik, Kortgen, Andreas, Preussler, Niels-Peter, Hofmann, Ulrich, Raber, Manfred, Reindl, Doris, Oppenrieder, Karin, Schierlinger, Bettina, Roth, Jens, Funk, Wolfgang, Fischer, Thomas, Gernoth, Christian, Wiefelsputz, Christina, Volger, Hauke, Zederer, Nicole, Diers, Anja, Huber, Matthias, Schorer, Clemens, Weyland, Andreas, Schwarzkopf, Konrad, Grau, Catharina, Roth, Winfried, Holy, Rolf, Mader, Thomas, Peter, Laura, Supthut, Hauke, Kuehhirt, Thomas, Milde, Alexander, Fiedler, Fritz, Isselhorst, Carsten, Grundmann, Ulrich, Pattar, Alexander, Reinert, Jennifer, Ehm, Birgit, Fritzsche, Katrin, Gaebler, Ralf, Meybohm, Patrick, Hein, Maximilian, Guzman, Ines, Jokinen, Johanna, Kranke, Peter, Goebel, Ulrich, Harris, Sarah, Eisner, Christoph, Ochsenreiter, Miriam, Schoeler, Michael, Thil, Elke, Ellerkmann, Richard, Hoeft, Andreas, Neumann, Claudia, Weber, Stefan, Keilhauer, Julia, Kloessing, Jan, Schramm, Michael, Trieschmann, Uwe, Knauss, Kristina, Sinner, Barbara, Steinmann, Johannes, Koessler, Herbert, Kalliardou, Evagelia, Malisiova, Anna, Tsiotou, Adelais, Chloropoulou, Pelagia, Chrysi, Mpratzou, Iordanidou, Despoina, Ntavlis, Merkourios, Rarosi, Ferenc, Boda, Krisztina B., Guerin, Christilynn, Irwin, Janice, Magner, Claire, Nakhjavani, Solmaz, O'Hare, Brendan, Galvin, Deborah, Jamil, Yosry, Lesmes, Carlos, Barak, Yuri, Fisher, Haran, Kachko, Ludmyla, Katz, Jacob, Kirilov, Dmitry, Levinzon, Michael, Manevich, Yair, Nekrasov, Konstantin, Peled, Elia, Sanko, Elena, Schmain, Dmitri, Sheinkin, Olga, Simhi, Eliahu, Tarabikin, Alex, Trabkin, Evelina, Yagudaev, Irena, Zeitlin, Yelena, Zunser, Igor, Habre, Walid, Disma, Nicola, Virag, Katalin, Becke, Karin, Hansen, Tom G., Joehr, Martin, Leva, Brigitte, Morton, Neil S., Vermeulen, Petronella M., Zielinska, Marzena, Boda, Krisztina, Veyckemans, Francis, Klimscha, Walter, Konecny, Regina, Luntzer, Robert, Morawk-Wintersperger, Ulrike, Neiger, Franz, Rustemeyer, Lydia, Breschan, Christian, Frey, Denise, Platzer, Manuela, Germann, Reinhard, Oeding, Joachim, Stoegermuller, Birgit, Ziegler, Bernhard, Brotatsch, Philipp, Gutmann, Anton, Mausser, Gerlinde, Messerer, Brigitte, Toller, Wolfgang, Vittinghoff, Maria, Zangl, Gregor, Seidel-Ahyai, Natascha, Hochhold, Christoph, Kroess, Ruth, Paal, Peter, Cnudde, Steven, Coucke, Patricia, Loveniers, Birgit, Mitchell, John, Kahn, David, Pirotte, Thierry, Pregardien, Caroline, Coppens, Marc, De Baerdemaeker, Luc, De Hert, Stefan, Heyse, Bjorn, Neckebroek, Martine, Parashchanka, Aliaksandra, Van Limmen, Jurgen, Van Den Eynde, Nancy, Vanpeteghem, Caroline, Wyffels, Piet, Lalot, Michael, Lechat, Jean-Paul, Stevens, France, Casaer, Sari, De Groote, Francoise, De Pooter, Francoise, De Ville, Andree, Gerin, Marc, Magasich, Natalia, Torres, Cristel Sanchez, Van Deenen, Denise, Berghmans, Johan, Himpe, Dirk, Roofthooft, Eva, Joukes, Ellen, Smitz, Carine, Van Reeth, Veronique, Huygens, Christel, Lauweryns, Julie, De Smet, Karen, Najafi, Nadia, Poelaert, Jan, Van de Velde, Anne, Van Mossevelde, Veerle, Bekavac, Ivan, Butkovic, Diana, Litvic, Dubravka Heli, Soric, Ivana Kerovec, Maretic, Hrvoje, Moscatello, Djurdjica, Popovic, Ljiljana, Micic, Slobodan, Tus, Ivana Stuck, Fabris, Lada Kalagac, Simurina, Tatjana, Sulen, Nina, Kesi-Valpotic, Gordana, Djapic, Dajana, Zurek, Jiri, Jureckova, Lucie, Mackova, Iveta, Skacel, Monika, Weinlichova, Stanislava, Divak, Jan, Frelich, Michal, Urbanec, Rene, Biskupova, Vera, Mixa, Vladimir, Pavlickova, Jana, Afshari, Arash, Bottger, Morten, Ellekvist, Marguerite B., Johansen, Mathias, Madsen, Birgitte Ingeborg, Nilsson, Jens Christian, Schousboe, Birgitte M. B., Clausen, Nicola G., Steen, Nick Phaff, Ilmoja, Mari-Liis, Tonise, Virge, Karjagin, Juri, Kikas, Reet, Isohanni, Mika, Lyly, Anniina, Takala, Annika, Happo, Johanna, Kiviluoma, Kai, Martikainen, Kati, Aantaa, Riku, Manner, Tuula, Vilo, Sanna, Amory, Catherine, Ludot, Hugues, Lambotte, Patricia, Busche, Rene, Jacqmarcq, Olivier, Lejus, Corinne, Corouge, Julien, Erb, Christian, Garrigue, Delphine, Gillet, Patricia, Laffargue, Anne, Lambelin, Veronique, Le Freche, Helene, Peresbota, Daliana, Richart, Pierre, Berton, Jerome, Chapotte, Catherine, Colbus, Laurent, Lehousse, Thierry, Monrigal, Jean, Baujard, Catherine, Roulleau, Philippe, Staiti, Giuseppe, Batoz, Helene, Bordes, Maryline, Didier, Anne, Hamonic, Yann, Lagarde, Sylvaine, Nouette-Gaulain, Karine, Semjen, Francois, Zaghet, Brigitte, Dekens, Jacky, Delcuze, Axelle, Dupont, Herve, Legrand, Aurelien, Raffoflandreur, Celine, Audren, Noemie, Camus, Blandine, Cartal, Marielle, Chazelet, Chantal, Davin, Isabelle, Guillier, Marion, Desjeux, Luc, Larcher, Claire, Grein, Elodie, Leclercq, Mickeal, Levitchi, Roxana, Rosu, Lilica, Simon, Dominique, Zang, Aurelien, Migeon, Anne, Gagey, Anne-Charlotte, Bourdaud, Nathalie, Carre, Anne-Charlotte, Duflo, Frederic, Riche, Jean-Claude, Robert, Philippe, Druot, Emilie, Maupain, Olivier, Orliaguet, Gilles, Sabau, Lucie, Taright, Hanna, Uhrig, Lynn, Verchere-Montmayeur, Juliette, Debrabant, Lise, Pilla, Clotaire, Podvin, Alexandre, Roth, Benjamin, Dahmani, Souhayl, Julien-Marsollier, Florence, Sabourdin, Nada, Alexandri, Bogdan, Brezac, Gilles, de la Briere, Francois, Hayem, Catherine, Lhubat, Elizabeth, Mission, Jean Paul, Remond, Charlotte, Dadure, Christophe, Maniora, Maud, Marie, Anais, Pirat, Philippe, Saour, Anne-Charlotte, Sola, Chrystelle, Ecoffey, Claude, Wodey, Eric, Adam, Christian, Standl, Thomas, Schindler, Ehrenfried, Yamamoto, Tomohiro, Brackhahn, Michael, Eich, Christoph Bernhard, Guericke, Holger, Kindermann, Petra, Laschat, Michael, Schink, Cornel, Wappler, Frank, Hoehne, Claudia, Skordou, Natalia, Ulrici, Johanna, Jetzek-Zader, Martin, Kienbaum, Peter, Meyer-Treschan, Tanja, Picker, Olaf, Schaefer, Maximilian S., Mielke, Golo, Baethge, Sabine, Ramminger, Axel, Bauer, Martin, Bollinger, Matthias, Hinz, Jose, Quintel, Michael, Russo, Sebastian G., Bauer, Michael, Geil, Dfominik, Kortgen, Andreas, Preussler, Niels-Peter, Hofmann, Ulrich, Raber, Manfred, Reindl, Doris, Oppenrieder, Karin, Schierlinger, Bettina, Roth, Jens, Funk, Wolfgang, Fischer, Thomas, Gernoth, Christian, Wiefelsputz, Christina, Volger, Hauke, Zederer, Nicole, Diers, Anja, Huber, Matthias, Schorer, Clemens, Weyland, Andreas, Schwarzkopf, Konrad, Grau, Catharina, Roth, Winfried, Holy, Rolf, Mader, Thomas, Peter, Laura, Supthut, Hauke, Kuehhirt, Thomas, Milde, Alexander, Fiedler, Fritz, Isselhorst, Carsten, Grundmann, Ulrich, Pattar, Alexander, Reinert, Jennifer, Ehm, Birgit, Fritzsche, Katrin, Gaebler, Ralf, Meybohm, Patrick, Hein, Maximilian, Guzman, Ines, Jokinen, Johanna, Kranke, Peter, Goebel, Ulrich, Harris, Sarah, Eisner, Christoph, Ochsenreiter, Miriam, Schoeler, Michael, Thil, Elke, Ellerkmann, Richard, Hoeft, Andreas, Neumann, Claudia, Weber, Stefan, Keilhauer, Julia, Kloessing, Jan, Schramm, Michael, Trieschmann, Uwe, Knauss, Kristina, Sinner, Barbara, Steinmann, Johannes, Koessler, Herbert, Kalliardou, Evagelia, Malisiova, Anna, Tsiotou, Adelais, Chloropoulou, Pelagia, Chrysi, Mpratzou, Iordanidou, Despoina, Ntavlis, Merkourios, Rarosi, Ferenc, Boda, Krisztina B., Guerin, Christilynn, Irwin, Janice, Magner, Claire, Nakhjavani, Solmaz, O'Hare, Brendan, Galvin, Deborah, Jamil, Yosry, Lesmes, Carlos, Barak, Yuri, Fisher, Haran, Kachko, Ludmyla, Katz, Jacob, Kirilov, Dmitry, Levinzon, Michael, Manevich, Yair, Nekrasov, Konstantin, Peled, Elia, Sanko, Elena, Schmain, Dmitri, Sheinkin, Olga, Simhi, Eliahu, Tarabikin, Alex, Trabkin, Evelina, Yagudaev, Irena, Zeitlin, Yelena, and Zunser, Igor

Abstract

Background Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. Methods The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered with ClinicalTrials.gov, number NCT01878760. Findings Between April 1, 2014, and Jan 31, 2015, 31 127 anaesthetic procedures in 30 874 children with a mean age of 6.35 years (SD 4.50) were included. The incidence of perioperative severe critical events was 5.2% (95% CI 5.0-5.5) with an incidence of respiratory critical events of 3.1% (2.9-3.3). Cardiovascular instability occurred in 1.9% (1.7-2.1), with an immediate poor outcome in 5.4% (3.7-7.5) of these cases. The all-cause 30-day in-hospital mortality rate was 10 in 10 000. This was independent of type of anaesthesia. Age (relative risk 0.88, 95% CI 0.86-0.90; p<0.0001), medical history, and physical condition (1.60, 1.40-1.82; p<0.0001) were the major risk factors for a serious critical event. Multivariate analysis revealed evidence for the beneficial effect of years of experience of the most senior anaesthesia team member (0.99, 0.981-0.997; p<0.0048 for respiratory critical events, and 0.98, 0.97-0.99; p=0.0039 for

Published
2017

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