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1010: DIFFICULT MASK VENTILATION IN CRITICALLY ILL CHILDREN INDEPENDENTLY ASSOCIATED WITH ADVERSE EVENTS

Introduction/Hypothesis: The epidemiology, risk factors, and clinical implications of difficult mask ventilation (MV) among critically ill children are not well studied. We hypothesize that 510% of critically ill children will have difficulty with MV in the PICU; specific patient, practice, and provider characteristics will be associated with difficult MV; and a higher occurrence of desaturation or specific tracheal intubation (TI) associated events (TIAEs) exist in children with difficult MV. Methods: We queried an international, 46-center, PICU TI safety database (NEAR4KIDS) for intubations between 1/201312/2018. Critically ill children who received MV as part of TI were included to define prevalence. We defined our primary outcome as the occurrence of specific TIAEs: hemodynamic TIAE (cardiac arrest, hyper/hypotension, dysrhythmia), emesis with/without aspiration, and/or oxygen desaturation (<80%). We identified patient-, practiceand provider-level factors associated with difficult MV using univariate analyses. After we evaluated the association between the presence of difficult MV and the primary outcome, a multivariable regression model was developed to identify an independent association between difficult MV and the primary outcome while controlling factors associated with difficult MV (p<0.05 as the threshold to include as a covariate). Results: Difficult MV was reported in 1,501 (9.5%) of 15,810 children undergoing TI with MV. Difficult MV was more commonly reported in patients with older age, primary respiratory diagnosis, respiratory indication for TI, presence of difficult airway features, higher provider level, and TIs without use of neuromuscular blockade (p<0.001). The primary outcome (specific TIAE or desaturation) occurred in 40.2% of patients with difficult MV vs. 19.8% in patients without difficult MV (p≤0.001). After adjusting for factors associated with difficult MV, the presence of difficult MV was independently associated with a higher occurrence of specific TIAEs and desaturation: OR 2.28 (95% CI 2.03-2.57, p≤0.001). Conclusions: Difficult MV was reported in 9.5% of critically ill children undergoing TI with MV and is independently associated with a higher occurrence of specific TI adverse events and oxygen desaturation. Future interventions should focus on improving MV delivery and safety.