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
{"title":"影响新生儿首次插管失败后再次插管成功的因素：来自全国新生儿紧急气道注册中心的报告。","authors":"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","doi":"10.1136/archdischild-2023-326501","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To determine the factors associated with second attempt success and the risk of adverse events following a failed first attempt at neonatal tracheal intubation.</p><p><strong>Design: </strong>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).</p><p><strong>Setting: </strong>Eighteen academic NICUs in NEAR4NEOS.</p><p><strong>Patients: </strong>Neonates requiring two or more attempts at intubation between October 2014 and December 2021.</p><p><strong>Main outcome measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Successful neonatal intubation on a second attempt was more likely with a change in intubator, stylet use or ETT size.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":" ","pages":"609-615"},"PeriodicalIF":3.9000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349927/pdf/","citationCount":"0","resultStr":"{\"title\":\"Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates.\",\"authors\":\"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\",\"doi\":\"10.1136/archdischild-2023-326501\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To determine the factors associated with second attempt success and the risk of adverse events following a failed first attempt at neonatal tracheal intubation.</p><p><strong>Design: </strong>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).</p><p><strong>Setting: </strong>Eighteen academic NICUs in NEAR4NEOS.</p><p><strong>Patients: </strong>Neonates requiring two or more attempts at intubation between October 2014 and December 2021.</p><p><strong>Main outcome measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Successful neonatal intubation on a second attempt was more likely with a change in intubator, stylet use or ETT size.</p>\",\"PeriodicalId\":8177,\"journal\":{\"name\":\"Archives of Disease in Childhood - Fetal and Neonatal Edition\",\"volume\":\" \",\"pages\":\"609-615\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-10-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11349927/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Disease in Childhood - Fetal and Neonatal Edition\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/archdischild-2023-326501\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Disease in Childhood - Fetal and Neonatal Edition","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/archdischild-2023-326501","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
摘要
目的确定新生儿气管插管首次尝试失败后与第二次尝试成功和不良事件风险相关的因素：对国家新生儿紧急气道注册中心（NEAR4NEOS）前瞻性收集的新生儿重症监护室（NICU）和产房插管数据进行回顾性分析：环境： NEAR4NEOS 中的 18 个学术新生儿重症监护室：主要结果指标：主要结果：第二次尝试插管成功为主要结果，严重气管插管相关事件（TIAE）或严重血氧饱和度下降（血氧饱和度下降≥20%）为次要结果。多变量回归研究了这些结果与患者特征和插管方法变化之间的关系：13 126 例患者中有 5805 例（44%）需要进行两次或两次以上的插管尝试，其中 3156 例（54%）在第二次尝试时成功。以下任何一项发生变化，第二次尝试成功的可能性都会增加：插管器（OR 1.80，95% CI 1.56 至 2.07）、插管器使用（OR 1.65，95% CI 1.36 至 2.01）或气管导管 (ETT) 大小（OR 2.11，95% CI 1.74 至 2.56）。插管器、喉镜类型或 ETT 大小的改变与严重失饱和的几率降低有关（OR 0.74，95% CI 0.61 至 0.90），但插管器或设备的改变与严重 TIAEs 无关：结论：改变插管器、喉镜类型或 ETT 大小，新生儿第二次插管成功的可能性更大。
Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates.
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.
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