Annery G. Garcia-Marcinkiewicz

Objectives: To determine the contemporary incidence of tracheal intubation–associated cardiac arrest (TI-CA) in critically ill children and identify potentially modifiable factors to prevent TI-CA in PICUs and pediatric cardiac ICUs (PCICUs). Design: Retrospective cohort study Setting: Seventy international PICUs and PCICUs Patients: Critically ill children requiring tracheal intubation in PICUs and PCICUs Interventions: Tracheal intubation data were prospectively collected for all initial intubations in 68 PICUs and PCICUs from January 2015 to December 2023 using the National Emergency Airway Registry for Children registry. Measurements and Main Results: TI-CA was defined as CA occurrence or receipt of chest compressions for at least 1 minute within 20 minutes of endotracheal tube placement. TI during ongoing cardiopulmonary resuscitation was not considered TI-CA. A total of 27,773 TIs were evaluated, with TI-CA reported in 1.2% ( n = 331). Pre-TI oxygenation failure and shock were associated with higher odds of TI-CA (adjusted odds ratio [aOR], 2.29; 95% CI, 1.81–2.89 and aOR, 4.67; 95% CI, 3.68–5.92, respectively). Each additional TI attempt required was associated with increased odds of TI-CA (aOR, 1.70; 95% CI, 1.56–1.85, for each attempt). Use of ketamine (aOR, 0.64; 95% CI, 0.49–0.82), propofol (aOR, 0.44; 95% CI, 0.27–0.72), neuromuscular blockade (aOR, 0.67; 95% CI, 0.49–0.91), and video laryngoscopy (aOR, 0.76; 95% CI, 0.6–0.97) were associated with lower odds of TI-CA. Mediation analysis indicated that 13% of video laryngoscopy’s protective effect was due to a reduction in TI attempt counts. The protective effects of ketamine, propofol, and neuromuscular blockade were minimally mediated by reduced TI attempt counts (5%, 4%, and 7%). Conclusions: TI-CA occurred in 1.2% of TIs performed in the PICUs. Odds of TI-CA increased incrementally with successive TI attempts. Video laryngoscopy was protective against TI-CA. Mediation analysis revealed that reduced TI attempts accounted for 13% of the protective benefit associated with video laryngoscopy.

Background: Patients undergoing palatoplasty experience perioperative adverse events. Identifying risk factors for perioperative adverse events and escalation of care may improve outcomes. Methods: Pediatric patients undergoing primary palatoplasty were included in this retrospective observational study performed at two academic children's hospitals from 2014 to 2020. Results: Four hundred fifty‐nine patients with a median age of 12 months (IQR: 10–17) and median weight of 9.3 kg (IQR: 8.3–10.9) were included. A perioperative adverse event occurred in 15% (69/459) patients. Multiple (> 1) perioperative adverse events occurred in 18 patients. Hypoxemia (42 events, 9.2%) was the most common perioperative adverse event, followed by upper airway obstruction (29 events, 6.3%), vomiting (11 events, 2.4%), hypoventilation (10 events, 2.2%), and bleeding (7 events, 1.5%). Two events required a rapid response team, and there was 1 cardiac arrest. Forty percent of perioperative adverse events occurred in the post‐anesthesia recovery area, and 24% occurred within 12 h of arriving to the floor. Prolonged emergence time (OR 1.04 [95% CI 1.02–1.06], p < 0.001) and nasal stent placement (OR 6.02 [95% CI 2.7–13.6], p < 0.001) were significantly associated with perioperative adverse events and increased odds of unanticipated admission to the pediatric intensive care unit (OR 1.02 [95% CI, 1.01–1.04], p < 0.001) and (OR 3.39 [95% CI, 1.19–8.83], p = 0.016), respectively. The occurrence of any perioperative adverse event (OR 8.47 [95% CI, 4.06–18], p < 0.001) and increasing number of perioperative adverse events (OR 1.75 [95% CI, 1.41–2.24], p < 0.001) were also associated with increased odds of unanticipated PICU admission. Conclusions: Patients undergoing palatoplasty are at risk of perioperative adverse events, particularly in post‐operative recovery areas, which may result in unanticipated escalation of care. Recognizing the risk factors associated with the development of perioperative adverse events may improve planning of post‐operative care and outcomes.

Background: Although clinical trials are fundamental to advancing evidence‐based practice, significant heterogeneity in outcome reporting poses a considerable challenge to the validity of systematic reviews. This inconsistency impedes the ability to compare, synthesise and interpret research findings effectively. In the field of paediatric airway management, this issue is particularly relevant because of the low incidence of critical events and the related high morbidity and mortality. The issue of inadequate and variable outcome reporting in clinical trials has been widely acknowledged, necessitating initiatives to enhance the quality of future research. Objective: This protocol delineates the methodology used for the development of standardised, consensus‐based outcome definitions and reporting items specifically tailored to paediatric airway management trials. The goal is to create guidance that will serve as an extension to the established SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) frameworks, leading to enhanced trial reproducibility and transparency and ultimately improve pediatric airway research, systematic reviews and advance patient care and safety. Methods: This project will adhere to the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network's framework for guideline development. The methodology will be structured into four distinct phases: (1) a scoping review to comprehensively identify outcomes and variables currently reported in paediatric airway management trials; (2) a three‐round Delphi process involving a multidisciplinary panel of experts to prioritise and refine outcomes and variables; (3) a consensus meeting to achieve agreement on the final set of reporting items, which will then be prepared for publication and (4) dissemination. Conclusions: The finalised outcome reporting guidelines, in the form of SPIRIT and CONSORT extensions for paediatric airway management, will be disseminated through various channels to maximise their reach and impact. These include publication in peer‐reviewed journals, presentation at major international conferences and submission to relevant international reporting registries, such as the EQUATOR, SPIRIT and CONSORT registries. Active engagement with key stakeholders, including journal editors, research funders, regulatory bodies and clinician networks and national and international societies, will be a crucial component of the dissemination strategy.

Introduction Surgery is a cost-effective public health intervention. Access to safe surgery is a basic human right. However, there are still significant disparities in the access to and safety of surgical and anaesthesia care between low-income and middle-income countries and high-income countries. The Latin American Surgical Outcomes Study in Paediatrics (LASOS-Peds) is an international, observational, 14-day cohort study to investigate the incidence of 30-day in-hospital complications following elective or emergency paediatric surgery in Latin American countries. Methods and analysis LASOS-Peds is a prospective, international, multicentre observational study of paediatric patients undergoing both elective and non-elective surgeries and procedures, inpatient and outpatient, including those performed outside the operating room. The primary outcome is the incidence of in-hospital postoperative complications up to 30 days after surgery. Secondary outcomes include intraoperative complications and the need for intensive care unit admission. Ethics and dissemination This study received approval from the Institutional Review Board of the coordinating centre (Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo) as well as from all the participating centres. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences. Trial registration number NCT05934682.