(1379) Variable Comfort of High-Risk Airway Management: A Multi-Institutional Survey

Introduction: High-risk pediatric tracheal intubations (TI) in patients with a difficult or critical airway (DA/CA) or with risk of tracheal intubation associated events (TIAEs) poses challenges for clinicians in the PICU. Formalized definitions are lacking, and little is known about clinicians' approaches to managing these patients. We aimed to describe perceived understanding and behaviors of clinicians in high-risk TIs. We hypothesized that there would be variability in definitions and reported practice between physicians and non-physicians.

Methods: We distributed a survey to PICU clinicians in the US through the NEAR4KIDS and PEDAL subgroups (PALISI network) aimed at understanding DA/CA definitions and clinician behaviors. The survey was sent to all members of these mailing lists from 1/2024 to 4/2024 and further distributed to clinical staff in their PICUs. We compared responses between physician and non-physician providers to questions targeted to individual behaviors in clinical scenarios using Chi2 with two-tailed alpha=0.05.

Results: Of 161 responses (80% PICU physicians, 20% RT/APPs), there were variable interpretations of what constitutes a DA/CA in relation to anatomic, physiologic, provider, and resource factors. Most clinicians reported the most helpful resource when performing TI in a DA/CA patient were anesthesiologists (70%). Compared with non-physicians, more physicians reported that they should be able to perform TI on children with some features of DA/ CA (non-physician 39% vs physician 78%, p< 0.001 ) or known DA (non-physician 23% vs physician 54%, p< 0.001 ) but not CA. There was significant variability between physicians and non-physicians when deciding who should intubate children with acute respiratory failure with high risk for TIAE (high BiPAP with FiO2=1.0). Compared with non-physicians, physicians more frequently reported tasking a trainee to perform both elective (61% vs. 29%, p< 0.001), and urgent TI (19% vs, 52%, p< 0.001).

Conclusions: Clinicians experience stress and uncertainty when dealing with TI cases with DA/CA or high risk for TIAE. There is a variability in clinician interpretation of DA/CA definitions and management strategies, underscoring the need for standardized guidelines to help minimize adverse outcomes.