Am J Perinatol 2020; 37(14): 1417-1424
DOI: 10.1055/s-0039-1693698
Original Article

Team Stress and Adverse Events during Neonatal Tracheal Intubations: A Report from NEAR4NEOS

1   Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
,
Taylor L. Sawyer
1   Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
,
Anne Ades
2   Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Stephen DeMeo
3   Department of Pediatrics, WakeMed Health and Hospitals, Raleigh, North Carolina
,
Elizabeth E. Foglia
2   Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Kristen Glass
4   Department of Pediatrics, Penn State Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
,
Megan M. Gray
1   Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
,
James Barry
5   Section of Neonatology, Department of Pediatrics, University of Colorado Hospital, University of Colorado School of Medicine, Aurora, Colorado
,
Lindsay Johnston
6   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
,
Philipp Jung
7   Department of Pediatrics, University Hospital Schleswig Holstein, Campus Luebeck, Luebeck, Germany
,
Jae H. Kim
8   Department of Pediatrics, Rady Children's Hospital-San Diego, University of California, San Diego, San Diego, California
,
Jeanne Krick
1   Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington
,
Ahmed Moussa
9   Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
,
Christine Mulvey
6   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
,
Vinay Nadkarni
10   Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
,
Natalie Napolitano
11   Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
,
Bin Huey Quek
12   Department of Neonatology, KK Women’s and Children’s Hospital, Singapore
,
Neetu Singh
13   Department of Pediatrics, Dartmouth Hitchcock Medical Center, West Lebanon, New Hampshire
,
Jeanne P. Zenge
5   Section of Neonatology, Department of Pediatrics, University of Colorado Hospital, University of Colorado School of Medicine, Aurora, Colorado
,
Justine Shults
14   Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
,
Akira Nishisaki
10   Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
,
for the National Emergency Airway Registry for Neonates (NEAR4NEOS) Investigators › Author Affiliations
Funding The current study is supported by Eunice Kennedy Shriver NICHD 1R21HD089151. A.A., T.L.S., A.N., and N.N. are supported by NICHD 1R21HD089151. A.N. and N.N. are also supported by AHRQ 1R18HS024511.

Abstract

Objective This study aimed to examine the association between team stress level and adverse tracheal intubation (TI)-associated events during neonatal intubations.

Study Design TIs from 10 academic neonatal intensive care units were analyzed. Team stress level was rated immediately after TI using a 7-point Likert scale (1 = high stress). Associations among team stress, adverse TI-associated events, and TI characteristics were evaluated.

Result In this study, 208 of 2,009 TIs (10%) had high stress levels (score < 4). Oxygenation failure, hemodynamic instability, and family presence were associated with high stress level. Video laryngoscopy and premedication were associated with lower stress levels. High stress level TIs were associated with adverse TI-associated event rates (31 vs. 16%, p < 0.001), which remained significant after adjusting for potential confounders including patient, provider, and practice factors associated with high stress (odds ratio: 1.90, 96% confidence interval: 1.36–2.67, p < 0.001).

Conclusion High team stress levels during TI were more frequently reported among TIs with adverse events.

Authors' Contributions

All authors are responsible for the reported research and have participated in the following: concept and design; acquisition, analysis, and interpretation of data; drafting and revising the article; approval of the version submitted.




Publication History

Received: 23 March 2019

Accepted: 13 June 2019

Article published online:
31 July 2019

© 2020. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
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