Pediatric Adverse Tracheal Intubation Associated Events Following Noninvasive Ventilation Failure
Bibliographic record
Abstract
Objective: To determine if children intubated after failed Noninvasive Ventilation (NIV) have a higher occurrence of Tracheal Intubation Associated Events (TIAEs) compared to those intubated immediately. Methods:We conducted a retrospective study of all Tracheal Intubations (TIs) in a tertiary pediatric intensive care unit from 1/2013 to 12/2015.Data were collected from National Airway Registry for Kids, Virtual PICU System, and chart review.We excluded TI in children on chronic NIV, endotracheal tube exchange, nonemergent TI for procedures, and cases with insufficient documentation.We defined NIV as continuous or bilevel pressure ≥5 cm H 2 O or high flow nasal cannula ≥4L/min for infants and ≥5L/min for children.NIV failure was defined as TI after >1h of exposure to NIV; it was further characterized as acute (1-4h) or delayed (>4h).Our primary outcome was occurrence of severe TIAEs and/or desaturation (SpO 2 drop >20%).Data were analyzed using Fisher's Exact Test, Chi Square, Mann-Whitney U Test, and logistic regression.Results: One-hundred-forty-four of 192 intubations (75%) were included, of which 48 (33%) were primary TIs and 96 (67%) were after NIV failure.The median duration of NIV prior to failure was 14h (IQR 5, 45).TIAEs/desaturation occurred in 33% of intubations and were not different between the two groups after adjusting for potential confounders (25% vs. 38%; p=0.134, aOR 2.15, 95% CI 0.77-6.03).Additionally, there was no difference between occurrence of severe TIAEs/ desaturation in acute compared to delayed NIV failure (26% vs. 19%; p=0.558).Conclusion: TI after NIV failure is common.However, there was no difference in the occurrence of severe TIAEs/desaturation in primary TI versus TI after NIV failure, suggesting NIV failure does not increase the risk of TIAEs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".