Airway: Arrived Intubated

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Description

This phenotype determines if a patient had an existing airway in place prior to anesthesia start time. Existing airways include intubation with ETT or existing tracheostomy prior to anesthesia start time.

Limitation

May include cancelled cases.

Cases where the patient was intubated in the days prior to the procedure but did not have any documented airway notes or included infusion medications in the time frames listed below may not be included.

Data quality is limited to individual site documentation accuracy, completeness, and variable mapping, which is performed by each site, independently. MPOG, as the coordinating center, reviews data quality at each data upload and monthly via Data Diagnostics and Case Validation tools. This review, while thorough, may not contain all data elements relevant to this phenotype and thus should be carefully reviewed by the user.

Value Type

Categorical

Enumeration

Value	Value Code	Definition

Return Columns

Name	Data Type

Granularity

Logic

This phenotype determines if a patient had an existing airway in place prior to arrival to the procedure room. This phenotype uses Observed Time. If Observed Time is not available, it will use Entered Time.

Step 1: Was case ASA 6? If No, proceed to step 2. If Yes, assign 'Arrived Intubated: Yes' and stop.

Step 2: Did Airway Type Notes return any of the below airway types? If No, result 'Arrived Intubated: No' and stop. If yes, go to step 2a.

Value	Value Code	Description
ETT	0	Note contains text indicating endotracheal tube was placed
Both ETT and LMA	3	Note contains text indicating ETT and LMA was used during case
Tracheostomy	6	Note contains text indicating a patient had a tracheostomy tube
In Situ	7	patient has existing endotracheal tube in place

Step 2a: Did Airway Type Notes return value of 7 'In Situ'? If Yes, assign Arrived Intubated: Yes and stop. If no, proceed to step 3.

Step 3: If Airway Type Notes returns value of 6 'Tracheostomy' and one of the following Surgical CPT codes (same date of surgery) then result 'Arrived Intubated: Yes' and stop. If no, proceed to step 4.

Surgical CPT code	CPT Description
31600	Tracheostomy, planned (separate procedure)
31601	Tracheostomy, planned (separate procedure); younger than 2 years
31603	Tracheostomy, emergency procedure; transtracheal
31605	Tracheostomy, emergency procedure; cricothyroid membrane
31610	Tracheostomy, fenestration procedure with skin flaps

Step 4: Is ventilator data (using the below concepts and parameters) documented within 4 hours prior to anesthesia start until anesthesia start? If yes, result 'Arrived Intubated: Yes' and stop. If no, proceed to step 5.

MPOG Concept ID	MPOG Concept	Expected Range
3151	Ventilator I:E Ratio I-Component	0.5-3
3152	Ventilator I:E Ratio E-Component	0.5-8
3199	Ventilator I:E Ratio	0.5-3 : 0.5-8 (see above)
3190	Tidal Volume Actual	50-900
3192	Tidal Volume Set	50-900
3195	Ventilator Respiratory Rate Actual	4-40
3198	Ventilator Respiratory Rate Set	4-40
3513	Ventilator Respiratory Rate Limit	4-40
3543	Ventilator - Pressure Support	0-35
3563	Ventilator - Inspiratory Time	0.5s-5s
70204	Respiratory - Mechanical Ventilation - PEEP	0-30
70205	Respiratory - Mechanical Ventilation - Pressure Limit	15-45
70001	Airway - Mallampati Score -- Unspecified Exam Position	contains intubated, ventilated, ventilator, bagging, ambu_bag, or ambubag AND does not contain no
70002	Airway - Freetext Comments	contains intubated, ventilated, ventilator, bagging, ambu_bag, or ambubag AND does not contain no
70003	Airway - Dentition	contains intubated, ventilated, ventilator, bagging, ambu_bag, or ambubag AND does not contain no

MPOG Concept: 70200 Respiratory - Mechanical Ventilation General

Contains	Exact	But not with
bivona	ett	none
cap	hme	extubated
cuff	pc	decannulated
in situ	pmv	removed
intubated, but not prior or previous	ac	n/a
mechanical ventialtion
pc-ac
simv
pressure
volume
shiley
stoma
trach
tracheostomy
trach collar
trach mask
uncuffed
vent
vent settings
ventilator

MPOG Concept 70203 Respiratory - Mechanical Ventilation - Mode and 3182 Ventilator Mode

Contains	Exact
A/C	ac
ac/pc	vc
acvc	pc
ac/vc	VAC
simv	VC
spont	VC+
spontaneous	vc+/ac
volume	VC+?SIMV
pressure	VCV
pc/ac	VGVAF
bilevl	psv
bilevel	VS
VC/AC	sVGVAF
APV/CMV	sVGVAF+PSV
apv/simv	PRVC
	PRVC/AC
	PS
	PS139
	PCV
	PCVVG
	HFJV
	IMV
	PAC
	APCcmv
	APRV
	apv
	APVcmv
	APVsimv139
	APVcmv139
	APVsimv

MPOG Concept: 3553 Ventilator - Pressure Control

Contains	Exact	But not with
CPAP	PSV	standby
Manual	AC-TV500 RR12	off
PCV	sv
PCV-VG	VCV
pressure control	VC
PSV Pro
SIMV
SIMV-PC
spontaneous
vent
VC-PG

Step 5: Did case have sedative medication administered via IV route (as an infusion) within 2 hours prior to anesthesia start? If Yes, proceed to step 5a. If No proceed to step 6.

Sedation Medication Concepts:

10020 ALFENTANIL
10149 DEXMEDETOMIDINE
10154 DIAZEPAM
10183 ETOMIDATE
10186 FENTANYL
10187 FENTANYL/MIDAZOLAM 40 MCG/ML / 200MCG/ML
10238 KETAMINE
10272 LORAZEPAM
10290 METHADONE
10292 METHOHEXITAL
10301 MIDAZOLAM
10377 PROPOFOL
10390 REMIFENTANIL
10414 SUFENTANIL
10427 THIOPENTAL
10453 PROPOFOL W/ KETAMINE 10 MG/ML + 1 MG/ML
10700 CLONAZEPAM

Step 5a: Was 50117, 50209, or 50074 (without the keywords listed in step 5) documented after anesthesia start? If Yes, assign 'Arrived Intubated: No' and stop. If No, Assign 'Arrived Intubated: Yes' and stop.

Step 6: Did case have existing airway concept documented within 4 hours of procedure start? If Yes, proceed to step 6a. If No, assign 'Arrived Intubated: No' and stop

MPOG Concept ID	MPOG Concept	Text
50208	Intubation view note	"in situ"
50628	Preinduction - Patient transported to OR by anesthesia team	"vent" "ICU"
50380	ETT in place, patient manually ventilated
50671	Intubation - endotracheal tube in situ
50105	Rhythm/Pattern (Respiratory)	"vent"
50074	Airway Type	"trach" "in situ" "existing"
50624	Airway - Supplemental oxygen delivered	"vent"

Step 6a: Was the existing airway concept 50117, 50209, or 50074 (without the keywords listed in step 5)? If No, assign 'Arrived Intubated: Yes' and stop.If Yes, assign 'Arrived Intubated: No' and stop.