Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates.
Mitchell David Johnson, David Gerald Tingay, Elizabeth J Perkins, Arun Sett, Bianca Devsam, Ellen Douglas, Julia K Charlton, Paul Wildenhain, Jennifer Rumpel, Michael Wagner, Vinay Nadkarni, Lindsay Johnston, Heidi M Herrick, Tyler Hartman, Kristen Glass, Philipp Jung, Stephen D DeMeo, Rebecca Shay, Jae H Kim, Jennifer Unrau, Ahmed Moussa, Akira Nishisaki, Elizabeth E Foglia
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引用次数: 0
Abstract
Objective: To determine the factors associated with second attempt success and the risk of adverse events following a failed first attempt at neonatal tracheal intubation.
Design: Retrospective analysis of prospectively collected data on intubations performed in the neonatal intensive care unit (NICU) and delivery room from the National Emergency Airway Registry for Neonates (NEAR4NEOS).
Setting: Eighteen academic NICUs in NEAR4NEOS.
Patients: Neonates requiring two or more attempts at intubation between October 2014 and December 2021.
Main outcome measures: The primary outcome was successful intubation on the second attempt, with severe tracheal intubation-associated events (TIAEs) or severe desaturation (≥20% decline in oxygen saturation) being secondary outcomes. Multivariate regression examined the associations between these outcomes and patient characteristics and changes in intubation practice.
Results: 5805 of 13 126 (44%) encounters required two or more intubation attempts, with 3156 (54%) successful on the second attempt. Second attempt success was more likely with changes in any of the following: intubator (OR 1.80, 95% CI 1.56 to 2.07), stylet use (OR 1.65, 95% CI 1.36 to 2.01) or endotracheal tube (ETT) size (OR 2.11, 95% CI 1.74 to 2.56). Changes in stylet use were associated with a reduced chance of severe desaturation (OR 0.74, 95% CI 0.61 to 0.90), but changes in intubator, laryngoscope type or ETT size were not; no changes in intubator or equipment were associated with severe TIAEs.
Conclusions: Successful neonatal intubation on a second attempt was more likely with a change in intubator, stylet use or ETT size.
期刊介绍:
Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.