Article Text

Download PDFPDF

Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: a report from the National Emergency Airway Registry for Neonates
  1. Taylor Sawyer1,
  2. Elizabeth E Foglia2,
  3. Anne Ades3,
  4. Ahmed Moussa4,
  5. Natalie Napolitano5,
  6. Kristen Glass6,
  7. Lindsay Johnston7,
  8. Philipp Jung8,
  9. Neetu Singh9,
  10. Bin Huey Quek10,
  11. James Barry11,
  12. Jeanne Zenge11,
  13. Stephen D DeMeo12,
  14. Brianna Brei13,
  15. Jeanne Krick13,
  16. Jae H Kim14,
  17. Vinay Nadkarni15,16,
  18. Akira Nishisaki15,16
  19. for the National Emergency Airway Registry for Neonates (NEAR4NEOS) investigators
  1. 1 Department of Pediatrics, University of Washington, Seattle, Washington, USA
  2. 2 Department of Pediatrics, Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  3. 3 Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
  4. 4 Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Sainte-Justine, Canada
  5. 5 Nursing and Respiratory Care, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  6. 6 Department of Pediatrics, Penn State – Hershey, Hershey, Pennsylvania, USA
  7. 7 Yale New Haven Health System, New Haven, Connecticut, USA
  8. 8 University Hospital Schleswig-Holstein, Department of Pediatrics, Luebeck, Germany
  9. 9 Department of Pediatrics, Dartmouth-Hitchcock Health System, Lebanon, New Hampshire, USA
  10. 10 Department of Neonatology, KK Women’s and Children’s Hospital, Singapore
  11. 11 Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
  12. 12 Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
  13. 13 Department of Pediatrics, University of Washington, Seattle, USA
  14. 14 Department of Pediatrics, University of California San Diego Medical Center, San Diego, California, USA
  15. 15 Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  16. 16 Center for Simulation, Advanced Education, and Innovation, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Taylor Sawyer, Department of Pediatrics, School of Medicine, University of Washington, Seattle WA 98195-6320, USA; tlsawyer{at}uw.edu

Abstract

Objective To determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU).

Design Retrospective review of prospectively collected data on intubations performed in the NICU from the National Emergency Airway Registry for Neonates.

Setting Ten academic NICUs.

Patients Neonates intubated in the NICU at each of the sites between October 2014 and March 2017.

Main outcome measures Difficult intubation was defined as one requiring three or more attempts by a non-resident provider. Patient (age, weight and bedside predictors of difficult intubation), practice (intubation method and medications used), provider (training level and profession) and outcome data (intubation attempts, adverse events and oxygen desaturations) were collected for each intubation.

Results Out of 2009 tracheal intubations, 276 (14%) met the definition of difficult intubation. Difficult intubations were more common in neonates <32 weeks, <1500 g. The difficult intubation group had a 4.9 odds ratio (OR) for experiencing an adverse event and a 4.2 OR for severe oxygen desaturation. Bedside screening tests of difficult intubation lacked sensitivity (receiver operator curve 0.47–0.53).

Conclusions Difficult intubations are common in the NICU and are associated with adverse event and severe oxygen desaturation. Difficult intubations occur more commonly in small preterm infants. The occurrence of a difficult intubation in other neonates is hard to predict due to the lack of sensitivity of bedside screening tests.

  • neonatal intubation
  • difficult intubation
  • difficult airway
  • intubation failure
  • intubation success
View Full Text

Statistics from Altmetric.com

Footnotes

  • Contributors The manuscript has been seen and approved by all authors and they have taken due care to ensure the integrity of the work. All authors have made substantial contributions to all of the following: (1) the conception and design of the manuscript, (2) drafting the article or revising it critically for important intellectual content and (3) final approval of the version to be submitted.

  • Funding TS is supported by NICHD 1R21HD091687 and 1R21HD089151. AN is supported by NICHD 1R21HD089151, AHRQ R18HS02264, R18HS024511. EEF is supported by an NICHD Career Development Award K23HD084727.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators The NEAR4NEOS.

  • Patient consent for publication Not required.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Editorial
    Colm Patrick Finbarr O’Donnell
  • Fantoms
    Ben J Stenson