Does videolaryngoscopy improve tracheal intubation first attempt success in the NICUs? A report from the NEAR4NEOS

Moussa, Ahmed; Sawyer, Taylor; Puia‐Dumitrescu, Mihai; Foglia, Elizabeth E.; Ades, Anne; Napolitano, Natalie; Glass, Kristen; Johnston, Lindsay; Jung, Philipp; Singh, Neetu; Quek, Bin Huey; Barry, James; Zenge, Jeanne; DeMeo, Stephen; Mehrem, Ayman Abou; Nishisaki, Akira

doi:10.1038/s41372-022-01472-9

Cited by 14 publications

(11 citation statements)

References 28 publications

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“…Our study nevertheless provides further evidence that VL is a feasible primary approach to tracheal intubation in critically ill term and preterm infants 14. Intubation is a highly complex procedure.…”

Section: Discussionmentioning

confidence: 55%

“…It was noticeable, however, that oesophageal intubation with concomitant desaturation did never occur in the VL group. Various studies have reported that oesophageal intubation is the most common and severe adverse TIAE 6 7 14 18. This raises the question which TIAEs are important and whether it is more important to prevent certain adverse TIAEs than others.…”

Section: Discussionmentioning

confidence: 99%

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Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trial

Tippmann

Schafer

Winter

et al. 2023

bmjpo

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ObjectiveTo assess whether video laryngoscopy (VL) for tracheal intubation of neonates results in a higher first-attempt success rate and fewer adverse tracheal intubation-associated events (TIAEs) when compared with direct laryngoscopy (DL).DesignSingle-centre, parallel group, randomised controlled trial.SettingUniversity Medical Centre Mainz, Germany.PatientsNeonates <440/7weeks postmenstrual age in whom tracheal intubation was indicated either in the delivery room or in the neonatal intensive care unit.InterventionIntubation encounters were randomly assigned to either VL or DL at first attempt.Primary outcomeFirst-attempt success rate during tracheal intubation.ResultsOf 121 intubation encounters assessed for eligibility, 32 (26.4%) were either not randomised (acute emergencies (n=9), clinicians’ preference for either VL (n=8) or DL (n=2)) or excluded from the analysis (declined parental consent (n=13)). Eighty-nine intubation encounters (41 in the VL and 48 in the DL group) in 63 patients were analysed. First-attempt success rate was 48.8% (20/41) in the VL group compared with 43.8% (21/48) in the DL group (OR 1.22, 95% CI 0.51 to 2.88).The frequency of adverse TIAEs was 43.9% (18/41) and 47.9% (23/48) in the VL and DL group, respectively (OR 0.85, 95% CI 0.37 to 1.97). Oesophageal intubation with concomitant desaturation never occurred in the VL group but in 18.8% (9/48) of intubation encounters in the DL group.ConclusionThis study provides effect sizes for first-attempt success rates and frequency of TIAEs with VL compared with DL in the neonatal emergency setting. This study was underpowered to detect small but clinically important differences between the two techniques. The results of this study may be useful in planning future trials.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trial

Tippmann

Schafer

Winter

et al. 2023

bmjpo

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“…A Cochrane systematic review of VL use in neonates reported increased success for the first attempt at TI, but no overall reduction in the number of TI attempts, with modest sample sizes and moderate to very low quality evidence 23. A more recent study from the NEAR4NEOS registry did not find any independent association between VL use and first attempt success 24. As both primary VL use and changing to VL for the second attempt were uncommon, our study was underpowered to make meaningful conclusions about the effects of VL on second attempt success.…”

Section: Discussionmentioning

confidence: 99%

Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates

Johnson,

Tingay,

Perkins

et al. 2024

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo determine the factors associated with second attempt success and the risk of adverse events following a failed first attempt at neonatal tracheal intubation.DesignRetrospective 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).SettingEighteen academic NICUs in NEAR4NEOS.PatientsNeonates requiring two or more attempts at intubation between October 2014 and December 2021.Main outcome measuresThe 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.Results5805 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.ConclusionsSuccessful neonatal intubation on a second attempt was more likely with a change in intubator, stylet use or ETT size.

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“…According to a retrospective review of prospective collected observational data from the NEAR4KIDS (National Emergency Airway Registry for Children) database, VL use was independently associated with a lower occurrence of TIAEs among PICUs and cardiac ICU patients ( 11 ). In neonatal settings, VL has also been proven to be clinically significant and has been associated with fewer TIAES when compared to DL use ( 6 , 12 , 13 ). In an extensive retrospective review of prospective collected observational data from the National Emergency Airway Registry for Neonates (NEAR4NEOS), Moussa et al found that, although VL use was not independently associated with higher TI first attempt success, it was associated with lower TIAEs ( 13 ).…”

mentioning

confidence: 99%

“…In neonatal settings, VL has also been proven to be clinically significant and has been associated with fewer TIAES when compared to DL use ( 6 , 12 , 13 ). In an extensive retrospective review of prospective collected observational data from the National Emergency Airway Registry for Neonates (NEAR4NEOS), Moussa et al found that, although VL use was not independently associated with higher TI first attempt success, it was associated with lower TIAEs ( 13 ). A systematic review that included three randomized trials that compared VL with DL for neonatal TI by trainees showed that VL increased IT first attempt success rate (moderate evidence) ( 12 ).…”

mentioning

confidence: 99%

Can video laryngoscopy and supplemental oxygen redefine pediatric, infant and neonatal tracheal intubation standards?

Coelho,

Couto

2024

Transl Pediatr

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Does videolaryngoscopy improve tracheal intubation first attempt success in the NICUs? A report from the NEAR4NEOS

Cited by 14 publications

References 28 publications

Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trial

Video versus direct laryngoscopy to improve the success rate of nasotracheal intubations in the neonatal intensive care setting: a randomised controlled trial

Factors that impact second attempt success for neonatal intubation following first attempt failure: a report from the National Emergency Airway Registry for Neonates

Can video laryngoscopy and supplemental oxygen redefine pediatric, infant and neonatal tracheal intubation standards?

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