Survival and short-term respiratory outcomes of <750 g infants initially intubated with 2.0 mm vs. 2.5 mm endotracheal tubes

Abstract

Objectives To compare survival and short-term respiratory outcomes of infants weighing <750 g initially intubated with 2.0 mm versus 2.5 mm endotracheal tube (ETT). Study design Retrospective, observational cohort study. Results Of 149 inborn infants weighing <750 g admitted to the NICU, 69 (46%) were intubated with 2.0 mm ETT, 78 with 2.5 mm ETT (53%), and 2 infants never required intubation. Infants intubated with 2.0 mm ETT were more premature (median gestational age (GA) 23 weeks (22, 24) vs. 24 weeks (24, 25) p < 0.0001), smaller (median birth weight 545 g (450, 616) vs. 648 g (579, 700), p < 0.0001), and more frequently intubated at delivery (96% vs. 68%, p < 0.00001). Survival to discharge was similar 77%, 53/69 and 87%, 68/78 ( p = 0.09). Adjusted for GA, there were no significant differences in ventilator days ( p = 0.7338) or Grade 3 BPD. Conclusions Premature infants born at a median GA of 23 weeks and median birth weight of 545 g can be successfully managed with 2.0 mm ETT.

First intention high-frequency jet ventilation for periviable infants

“…At Iowa, all periviable infants born at 22–23 weeks are intubated in the delivery room with either a 2.0 or 2.5 mm ETT and within 10 min of life placed on first intention HFJV for lung protection to reduce the risks of volutrauma. We have recently shown that infants (median gestation age 23 weeks, interquartile range (IQR) 22–24 weeks, birthweight median 545 g, IQR 450–615 g) can be successfully managed on HFJV with a 2.0 mm ETT with a survival rate of 77% [28 ▪▪ ]. Infants born at less than 24 weeks gestation are started on a jet rate of 300 BPM with an inspiratory time of 0.02 s for an inspiratory to expiratory (I : E) ratio of 1 : 9.…”