310: COVID-19 Impact on Pediatric Tracheal Intubation Practice in the Pediatric ICU

INTRODUCTION: Bag mask ventilation (BMV) and tracheal intubation (TI) are aerosol generating procedures The COVID-19 pandemic impacted North America since March 2020, possibly altering TI practice We hypothesized that during COVID-19 there was more use of rapid sequence intubation (RSI) without BMV and more use of video laryngoscopy (VL) and apneic oxygenation (AO) as techniques to reduce patient to provider transmission of SARS CoV 2 METHODS: Prospective observational cohort of initial TIs from NEAR4KIDS database: two periods (April-June 2019: Pre-COVID and April-June 2020: COVID) were chosen We evaluated the difference in patient, provider, and practice characteristics as well as the adverse TI associated events (TIAEs) and oxygen desaturation (SpO2<80%) between two periods RESULTS: 749 primary TIs were reported from 38 centers during Pre-COVID, and 374 TIs from 30 centers during COVID Patient median age was older in COVID-19 pandemic (Pre-COVID 1y (IQR 0-8), COVID 2yr (IQR 0-13), p=0 005) RSI without BMV was more frequently used during COVID-19 (4% Pre-COVID vs 13% COVID, p<0 001) VL and AO were more commonly used during COVID-19 (VL: Pre-COVID 48% vs COVID 68%, p<0 001;AO: Pre-COVID 30% vs COVID 44%, p<0 001) The proportion of attending intubation increased during pandemic (Pre-COVID 20% vs COVID 27%) and the resident and fellow intubations decreased (Pre-COVID 60% vs COVID 48%) The adverse TIAEs were not significantly different (Pre-COVID 11% vs COVID 12%, p=0 74), and desaturation (SpO2<80%) were not different (Pre-COVID 15% vs COVID 17%, p=0 60) CONCLUSIONS: In this preliminary analysis, more senior providers served as a primary laryngoscopist, more rapid sequence intubation (RSI) without BMV was provided, and video laryngoscopy (VL) and apneic oxygenation (AO) were used more during the COVID-19 pandemic TIs However, adverse TI associated events (TIAEs) and oxygen desaturation (SpO2<80%) were NOT more common during the COVID-19 era