Abstract
Background: Intubation of neonates is difficult and hazardous. Factors associated with procedure-related adverse events and unsuccessful intubation attempts are insufficiently evaluated, especially during neonatal nasotracheal intubations.Objective: Aim of this study was to determine the frequency of tracheal intubation–associated events (TIAEs) during neonatal nasotracheal intubations and to identify factors associated with TIAEs and unsuccessful intubation attempts in our neonatal unit.Methods: This was a prospective, single-site, observational study from May 2017 to November 2019, performed at a tertiary care neonatal intensive care unit in a German academic teaching hospital. All endotracheal intubation encounters performed by the neonatal team were recorded.Results: Two hundred and fifty-eight consecutive intubation encounters in 197 patients were analyzed. One hundred and forty-eight (57.4%) intubation encounters were associated with at least one TIAE. Intubation inexperience (<10 intubation encounters) (OR = 2.15; 95% CI, 1.257–3.685) and equipment problems (OR = 3.43; 95% CI, 1.12–10.52) were predictive of TIAEs. Intubation at first attempt (OR = 0.10; 95% CI, 0.06–0.19) and videolaryngoscopy (OR = 0.47; 96% CI, 0.25–0.860) were predictive of intubation encounters without TIAEs. The first intubation attempt was commonly done by pediatric residents (67.8%). A median of two attempts were performed until successful intubation. Restricted laryngoscopic view (OR = 3.07; 95% CI, 2.08–4.53; Cormack-Lehane grade 2 vs. grade 1), intubation by pediatric residents when compared to neonatologists (OR = 1.74; 95% CI, 1.265–2.41) and support by less experienced neonatal nurses (OR = 1.60; 95% CI, 1.04–2.46) were associated with unsuccessful intubation attempts.Conclusions: In our unit, TIAEs and unsuccessful intubation attempts occurred frequently during neonatal nasotracheal intubations. To improve success rates, quality improvement und further research should target interprofessional education and training, equipment problems and videolaryngoscopy.
Highlights
In neonates, endotracheal intubation and mechanical ventilation are avoided whenever possible to reduce damage of the immature lung [1]
Aim of this study was to determine the frequency of Tracheal intubation–associated events (TIAEs) during neonatal nasotracheal intubations and to identify factors associated with TIAEs and unsuccessful intubation attempts in our neonatal unit
Most intubation encounters occurred in the delivery room (DR) (52.7%)
Summary
Endotracheal intubation and mechanical ventilation are avoided whenever possible to reduce damage of the immature lung [1]. Endotracheal intubation is a necessary and frequently performed procedure. Endotracheal intubation of neonates is often lifesaving and difficult to perform and hazardous. Tracheal intubation–associated events (TIAEs) occur in up to 40% of neonatal intubations [4]. There is an evident lack of knowledge on TIAEs and success rates in neonatal centers outside the US. This is of particular importance since many centers in Europe prefer nasotracheal to orotracheal intubation. Aim of this study was to determine the frequency of TIAEs during neonatal nasotracheal intubations and to identify factors associated with TIAEs and unsuccessful intubation attempts in our neonatal unit. Factors associated with procedure-related adverse events and unsuccessful intubation attempts are insufficiently evaluated, especially during neonatal nasotracheal intubations
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