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
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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.
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