Kathleen Miller, Nicole Pouppirt, Paul Wildenhain, Ayman Abou Mehrem, Ivana Brajkovic, Cassandra DeMartino, Kristen Glass, Kate Alison Hodgson, Philipp Jung, Ahmed Moussa, Mihai Puia-Dumitrescu, Binhuey Quek, Jennifer Rumpel, Rebecca Shay, David Tingay, Michelle D Tyler, Jennifer Unrau, Michael Wagner, Justine Shults, Akira Nishisaki, Elizabeth E Foglia, Heidi M Herrick
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The primary outcome was first-attempt success. Secondary outcomes included number of attempts, adverse tracheal intubation-associated events (TIAEs), severe TIAEs, desaturation and bradycardia. Descriptive statistics compared characteristics for ETT exchanges and primary intubations. Univariable and multivariable analyses compared primary and secondary outcomes and identified factors independently associated with ETT exchange outcomes.</p><p><strong>Results: </strong>A total of 1572 ETT exchanges and 9999 primary intubations across 21 sites were included from October 2014 to September 2022. ETT exchanges represented 2.3%-31.2% (mean 13.6%) of intubations across sites. Patient, provider and practice characteristics varied significantly between ETT exchanges and primary intubations. In univariable analyses, ETT exchanges were associated with higher first-attempt success (70.5% vs 53.6%; p<0.001) and fewer safety events. In multivariable analyses, ETT exchanges were associated with an increased adjusted OR (aOR) of first-attempt success (1.71; 95% CI 1.57 to 1.86; p<0.001). ETT exchanges were associated with lower aOR of all safety outcomes except severe TIAEs. Factors independently associated with ETT exchange first-attempt success included video laryngoscopy and paralytic premedication.</p><p><strong>Conclusion: </strong>Compared with primary intubations, ETT exchanges were associated with higher first-attempt success and fewer safety events. 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ETT exchanges are the placement of a new ETT when one is already in place, whereas primary intubations do not have a pre-existing ETT. The primary outcome was first-attempt success. Secondary outcomes included number of attempts, adverse tracheal intubation-associated events (TIAEs), severe TIAEs, desaturation and bradycardia. Descriptive statistics compared characteristics for ETT exchanges and primary intubations. Univariable and multivariable analyses compared primary and secondary outcomes and identified factors independently associated with ETT exchange outcomes.</p><p><strong>Results: </strong>A total of 1572 ETT exchanges and 9999 primary intubations across 21 sites were included from October 2014 to September 2022. ETT exchanges represented 2.3%-31.2% (mean 13.6%) of intubations across sites. Patient, provider and practice characteristics varied significantly between ETT exchanges and primary intubations. In univariable analyses, ETT exchanges were associated with higher first-attempt success (70.5% vs 53.6%; p<0.001) and fewer safety events. In multivariable analyses, ETT exchanges were associated with an increased adjusted OR (aOR) of first-attempt success (1.71; 95% CI 1.57 to 1.86; p<0.001). ETT exchanges were associated with lower aOR of all safety outcomes except severe TIAEs. Factors independently associated with ETT exchange first-attempt success included video laryngoscopy and paralytic premedication.</p><p><strong>Conclusion: </strong>Compared with primary intubations, ETT exchanges were associated with higher first-attempt success and fewer safety events. 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引用次数: 0
摘要
目的：比较气管内插管（ETT）置换与初次插管的成功率和安全性，并确定与ETT置换结果相关的因素。设计：前瞻性收集国家新生儿急诊气道登记资料的回顾性观察研究。气管插管交换是指在已经有气管插管的情况下放置新的气管插管，而初级插管没有预先存在的气管插管。主要结果是第一次尝试成功。次要结局包括尝试次数、不良气管插管相关事件（tiae）、严重tiae、去饱和和心动过缓。描述性统计比较了ETT交换和首次插管的特征。单变量和多变量分析比较了主要和次要结果，并确定了与ETT交换结果独立相关的因素。结果：2014年10月至2022年9月，共纳入21个地点的1572例ETT交换和9999例初次插管。ETT交换占各站点插管的2.3%-31.2%（平均13.6%）。患者、提供者和实践特征在ETT交换和初次插管之间有显著差异。在单变量分析中，ETT交换与更高的首次尝试成功率相关(70.5% vs 53.6%；结论：与首次插管相比，ETT交换与更高的首次尝试成功率和更少的安全事件相关。视频喉镜和麻痹前用药与ETT交换结果的改善有关。
Success and safety of neonatal endotracheal tube exchanges: a NEAR4NEOS multicentre retrospective cohort study.
Objectives: To compare success and safety of endotracheal tube (ETT) exchanges with primary intubations and identify factors associated with ETT exchange outcomes.
Design: Retrospective observational study of prospectively collected National Emergency Airway Registry for Neonates data. ETT exchanges are the placement of a new ETT when one is already in place, whereas primary intubations do not have a pre-existing ETT. The primary outcome was first-attempt success. Secondary outcomes included number of attempts, adverse tracheal intubation-associated events (TIAEs), severe TIAEs, desaturation and bradycardia. Descriptive statistics compared characteristics for ETT exchanges and primary intubations. Univariable and multivariable analyses compared primary and secondary outcomes and identified factors independently associated with ETT exchange outcomes.
Results: A total of 1572 ETT exchanges and 9999 primary intubations across 21 sites were included from October 2014 to September 2022. ETT exchanges represented 2.3%-31.2% (mean 13.6%) of intubations across sites. Patient, provider and practice characteristics varied significantly between ETT exchanges and primary intubations. In univariable analyses, ETT exchanges were associated with higher first-attempt success (70.5% vs 53.6%; p<0.001) and fewer safety events. In multivariable analyses, ETT exchanges were associated with an increased adjusted OR (aOR) of first-attempt success (1.71; 95% CI 1.57 to 1.86; p<0.001). ETT exchanges were associated with lower aOR of all safety outcomes except severe TIAEs. Factors independently associated with ETT exchange first-attempt success included video laryngoscopy and paralytic premedication.
Conclusion: Compared with primary intubations, ETT exchanges were associated with higher first-attempt success and fewer safety events. Video laryngoscope and paralytic premedication were associated with improved ETT exchange outcomes.
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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