3 results on '"Nadkarni, Vinay"'
Search Results
2. Cricoid Pressure During Induction for Tracheal Intubation in Critically Ill Children: A Report From National Emergency Airway Registry for Children.
- Author
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Kojima T, Harwayne-Gidansky I, Shenoi AN, Owen EB, Napolitano N, Rehder KJ, Adu-Darko MA, Nett ST, Spear D, Meyer K, Giuliano JS Jr, Tarquinio KM, Sanders RC Jr, Lee JH, Simon DW, Vanderford PA, Lee AY, Brown CA 3rd, Skippen PW, Breuer RK, Toedt-Pingel I, Parsons SJ, Gradidge EA, Glater LB, Culver K, Nadkarni VM, and Nishisaki A
- Subjects
- Canada, Child, Child, Preschool, Cohort Studies, Female, Humans, Infant, Intensive Care Units, Pediatric, Intubation, Intratracheal methods, Japan, Laryngopharyngeal Reflux etiology, Laryngopharyngeal Reflux prevention & control, Laryngoscopy adverse effects, Male, New Zealand, Pressure, Propensity Score, Quality Improvement, Registries, Retrospective Studies, Singapore, United States, Cricoid Cartilage physiopathology, Critical Illness therapy, Intubation, Intratracheal adverse effects, Laryngopharyngeal Reflux epidemiology
- Abstract
Objectives: Cricoid pressure is often used to prevent regurgitation during induction and mask ventilation prior to high-risk tracheal intubation in critically ill children. Clinical data in children showing benefit are limited. Our objective was to evaluate the association between cricoid pressure use and the occurrence of regurgitation during tracheal intubation for critically ill children in PICU., Design: A retrospective cohort study of a multicenter pediatric airway quality improvement registry., Settings: Thirty-five PICUs within general and children's hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand)., Patients: Children (< 18 yr) with initial tracheal intubation using direct laryngoscopy in PICUs between July 2010 and December 2015., Interventions: None., Measurements and Main Results: Multivariable logistic regression analysis was used to evaluate the association between cricoid pressure use and the occurrence of regurgitation while adjusting for underlying differences in patient and clinical care factors. Of 7,825 events, cricoid pressure was used in 1,819 (23%). Regurgitation was reported in 106 of 7,825 (1.4%) and clinical aspiration in 51 of 7,825 (0.7%). Regurgitation was reported in 35 of 1,819 (1.9%) with cricoid pressure, and 71 of 6,006 (1.2%) without cricoid pressure (unadjusted odds ratio, 1.64; 95% CI, 1.09-2.47; p = 0.018). On multivariable analysis, cricoid pressure was not associated with the occurrence of regurgitation after adjusting for patient, practice, and known regurgitation risk factors (adjusted odds ratio, 1.57; 95% CI, 0.99-2.47; p = 0.054). A sensitivity analysis in propensity score-matched cohorts showed cricoid pressure was associated with a higher regurgitation rate (adjusted odds ratio, 1.01; 95% CI, 1.00-1.02; p = 0.036)., Conclusions: Cricoid pressure during induction and mask ventilation before tracheal intubation in the current ICU practice was not associated with a lower regurgitation rate after adjusting for previously reported confounders. Further studies are needed to determine whether cricoid pressure for specific indication with proper maneuver would be effective in reducing regurgitation events.
- Published
- 2018
- Full Text
- View/download PDF
3. Clinical Impact of External Laryngeal Manipulation During Laryngoscopy on Tracheal Intubation Success in Critically Ill Children.
- Author
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Kojima T, Laverriere EK, Owen EB, Harwayne-Gidansky I, Shenoi AN, Napolitano N, Rehder KJ, Adu-Darko MA, Nett ST, Spear D, Meyer K, Giuliano JS Jr, Tarquinio KM, Sanders RC Jr, Lee JH, Simon DW, Vanderford PA, Lee AY, Brown CA 3rd, Skippen PW, Breuer RK, Toedt-Pingel I, Parsons SJ, Gradidge EA, Glater LB, Culver K, Li S, Polikoff LA, Howell JD, Nuthall G, Bysani GK, Graciano AL, Emeriaud G, Saito O, Orioles A, Walson K, Jung P, Al-Subu AM, Ikeyama T, Shetty R, Yoder KM, Nadkarni VM, and Nishisaki A
- Subjects
- Canada, Child, Child, Preschool, Female, Humans, Infant, Intensive Care Units, Pediatric, Japan, Larynx, Male, New Zealand, Propensity Score, Quality Improvement, Registries, Retrospective Studies, Singapore, United States, Critical Illness therapy, Intubation, Intratracheal methods, Laryngoscopy methods
- Abstract
Objectives: External laryngeal manipulation is a commonly used maneuver to improve visualization of the glottis during tracheal intubation in children. However, the effectiveness to improve tracheal intubation attempt success rate in the nonanesthesia setting is not clear. The study objective was to evaluate the association between external laryngeal manipulation use and initial tracheal intubation attempt success in PICUs., Design: A retrospective observational study using a multicenter emergency airway quality improvement registry., Setting: Thirty-five PICUs within general and children's hospitals (29 in the United States, three in Canada, one in Japan, one in Singapore, and one in New Zealand)., Patients: Critically ill children (< 18 years) undergoing initial tracheal intubation with direct laryngoscopy in PICUs between July 1, 2010, and December 31, 2015., Measurements and Main Results: Propensity score-matched analysis was performed to evaluate the association between external laryngeal manipulation and initial attempt success while adjusting for underlying differences in patient and clinical care factors: age, obesity, tracheal intubation indications, difficult airway features, provider training level, and neuromuscular blockade use. External laryngeal manipulation was defined as any external force to the neck during laryngoscopy. Of the 7,825 tracheal intubations, the initial tracheal intubation attempt was successful in 1,935/3,274 intubations (59%) with external laryngeal manipulation and 3,086/4,551 (68%) without external laryngeal manipulation (unadjusted odds ratio, 0.69; 95% CI, 0.62-0.75; p < 0.001). In propensity score-matched analysis, external laryngeal manipulation remained associated with lower initial tracheal intubation attempt success (adjusted odds ratio, 0.93; 95% CI, 0.90-0.95; p < 0.001)., Conclusions: External laryngeal manipulation during direct laryngoscopy was associated with lower initial tracheal intubation attempt success in critically ill children, even after adjusting for underlying differences in patient factors and provider levels. The indiscriminate use of external laryngeal manipulation cannot be recommended.
- Published
- 2018
- Full Text
- View/download PDF
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