Factors Associated with Adverse Events during Tracheal Intubation in the NICU

Foglia, Elizabeth E.; Ades, Anne; Napolitano, Natalie; Leffelman, Jessica; Nadkarni, Vinay; Nishisaki, Akira

doi:10.1159/000381252

Cited by 92 publications

(112 citation statements)

References 26 publications

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“…These studies have consistently identified experience level and provider discipline as significant factors associated with intubation success (Fig. 1) [1][2][3][4][5][6][7][8]. Experienced providers, such as attending neonatologists, have the highest success rates of around 64%.…”

Section: Neonatal Intubation Success Rates and Complicationsmentioning

confidence: 96%

“…Experienced providers, such as attending neonatologists, have the highest success rates of around 64%. Novice providers, such as pediatric residents, have the lowest success rates, with success rates of only 20-26% [6][7][8]. Pediatric residents' suboptimal success rates likely stem from the limited experience with neonatal intubation.…”

Section: Neonatal Intubation Success Rates and Complicationsmentioning

confidence: 99%

“…1. Neonatal intubation first attempt success rates, presented as mean ± standard deviation, by provider type based on pooled data from eight published single center and multicenter observational studies (8,066 total intubations) [1][2][3][4][5][6][7][8]. First attempt success rates by provider type are as follows: pediatric residents 42 ± 9%, NICU non-physician clinicians (nurse practitioners, physician assistants, respiratory therapists and transport nurses) 52 ± 9%, NICU fellow 63 ± 14%, NICU attending 64 ± 16%.…”

Section: Neonatal Intubation Success Rates and Complicationsmentioning

confidence: 99%

“…Foglia et al conducted a single-center prospective observational cohort study of infants intubated in a level IV referral NICU. The authors reported an adverse event rate of 22%, with the most common events being esophageal intubation (16%), mainstem intubation (2%), oral/airway trauma (2.7%), vomiting (1.6%) and cardiac arrest (0.9%) [7]. Severe oxygen desaturation, defined as ≥20% decrease in oxygen saturation, occurred in 51% of encounters [7].…”

Section: Neonatal Intubation Success Rates and Complicationsmentioning

confidence: 99%

“…The authors reported an adverse event rate of 22%, with the most common events being esophageal intubation (16%), mainstem intubation (2%), oral/airway trauma (2.7%), vomiting (1.6%) and cardiac arrest (0.9%) [7]. Severe oxygen desaturation, defined as ≥20% decrease in oxygen saturation, occurred in 51% of encounters [7]. Hatch et al studied intubations in a level IV academic NICU and reported an adverse event rate of 39% [8].…”

Section: Neonatal Intubation Success Rates and Complicationsmentioning

confidence: 99%

See 4 more Smart Citations

Improving neonatal intubation safety: A journey of a thousand miles

Sawyer

Foglia

Hatch

et al. 2017

NPM

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Abstract. Neonatal intubation is one of the most common procedures performed by neonatologists, however, the procedure is difficult and high risk. Neonates who endure the procedure often experience adverse events, including bradycardia and severe oxygen desaturations. Because of low first attempt success rates, neonates are often subjected to multiple intubation attempts before the endotracheal tube is successfully placed. These factors conspire to make intubation one of the most dangerous procedures in neonatal medicine. In this commentary we review key elements in the journey to improve neonatal intubation safety. We begin with a review of intubation success rates and complications. Then, we discuss the importance of intubation training. Next, we examine quality improvement efforts and patient safety research to improve neonatal intubation safety. Finally, we evaluate new tools which may improve success rates, and decrease complications during neonatal intubation.

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Section: Neonatal Intubation Success Rates and Complicationsmentioning

confidence: 96%

Section: Neonatal Intubation Success Rates and Complicationsmentioning

confidence: 99%

Section: Neonatal Intubation Success Rates and Complicationsmentioning

confidence: 99%

Section: Neonatal Intubation Success Rates and Complicationsmentioning

confidence: 99%

Section: Neonatal Intubation Success Rates and Complicationsmentioning

confidence: 99%

See 3 more Smart Citations

Improving neonatal intubation safety: A journey of a thousand miles

Sawyer

Foglia

Hatch

et al. 2017

NPM

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Premedication practices for neonatal tracheal intubation: Results from the EPIPPAIN 2 prospective cohort study and comparison with EPIPPAIN 1

Walter-Nicolet

Marchand-Martin

Guellec

et al. 2021

Paediatric and Neonatal Pain

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To describe the frequency and nature of premedication practices for neonatal tracheal intubation (TI) in 2011; to identify independent risk factors for the absence of premedication; to compare data with those from 2005 and to confront observed practices with current recommendations. Data concerning TI performed in neonates during the first 14 days of their admission to participating neonatal/pediatric intensive care units were prospectively collected at the bedside. This study was part of the Epidemiology of Procedural Pain in Neonates study (EPIPPAIN 2) conducted in 16 tertiary care units in the region of Paris, France, in 2011. Multivariate analysis was used to identify factors associated with premedication use and multilevel analysis to identify center effect. Results were compared with those of the EPIPPAIN 1 study, conducted in 2005 with a similar design, and to a current guidance for the clinician for this procedure. One hundred and twenty-one intubations carried out in 121 patients were analyzed. The specific premedication rate was 47% and drugs used included mainly propofol (26%), sufentanil (24%), and ketamine (12%). Three factors were associated with the use of a specific premedication: nonemergent TI (Odds ratio (OR) [95% CI]: 5.3 [1.49-20.80]), existence of a specific written protocol in the ward (OR [95% CI]:4.80 [2.12-11.57]), and the absence of a nonspecific concurrent analgesia infusion before TI (OR [95% CI]: 3.41 [1.46-8.45]). No center effect was observed. The specific premedication rate was lower than the 56% rate observed in 2005. The drugs used were more homogenous and consistent with the current recommendations than in 2005, especially in centers with a specific written protocol.Premedication use prior to neonatal TI was low, even for nonemergent procedures.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Patient characteristics associated with complications during neonatal intubations

Glenn

Sudhakar

Markowski

et al. 2021

Pediatric Pulmonology

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Introduction: Complications of neonatal intubation are known to be increased with emergent intubations, increased number of attempts, unstable hemodynamics, or ventilation failure; and decreased with use of paralytic medication and videolaryngoscopy. Patient characteristics associated with complications are not well understood. Design/Methods: A retrospective cohort study was performed of neonates who underwent intubation between January 2017 and June 2019. Patient characteristics of infants with and without complications were compared. Complications included common adverse events and abnormal vital sign changes occurring during intubation.Results: A total of 467 intubation encounters in 352 infants were included with median gestational age (GA) at birth of 29 weeks, postmenstrual age (PMA) 33 weeks at intubation, and median weight 1795 g. 41.5% of infants had complications and 58.5% of infants did not. Infants with complications compared to infants without had a median FiO 2 of 0.50 versus 0.45 (p = .183), median GA at birth of 29 versus 31 weeks (p < .001), median PMA of 32 weeks versus 33.0 weeks (p = .352), median weight of 1540 g versus 1970g (p = .091), and median chronological age of 3 days versus 1 day (p = .001). Generalized Estimating Equations controlling for administration of paralytic indicated decreased complications in infants ≤21.5 days in chronological age (OR, 0.45; 95% CI, 0.30-0.69) and increased complications in infants ≤1565 g (OR, 1.52; 95% CI, 1.04-2.23). Conclusion:Patient characteristics associated with an increased rate of complications included chronological age and weight. Further study is needed to reduce complications.

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Factors Associated with Adverse Events during Tracheal Intubation in the NICU

Cited by 92 publications

References 26 publications

Improving neonatal intubation safety: A journey of a thousand miles

Improving neonatal intubation safety: A journey of a thousand miles

Premedication practices for neonatal tracheal intubation: Results from the EPIPPAIN 2 prospective cohort study and comparison with EPIPPAIN 1

Patient characteristics associated with complications during neonatal intubations

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