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Observational Study
. 2015;108(1):23-9.
doi: 10.1159/000381252. Epub 2015 May 6.

Factors Associated with Adverse Events during Tracheal Intubation in the NICU

Elizabeth E Foglia  1 , Anne Ades, Natalie Napolitano, Jessica Leffelman, Vinay Nadkarni, Akira Nishisaki
Affiliations
Observational Study

Factors Associated with Adverse Events during Tracheal Intubation in the NICU

Elizabeth E Foglia et al. Neonatology. 2015.

Abstract

Background: The incidence of adverse tracheal intubation-associated events (TIAEs) and associated patient, practice, and intubator characteristics in the neonatal intensive care unit (NICU) setting are unknown.

Objectives: To determine the incidence of adverse TIAEs and to identify factors associated with TIAEs in the NICU.

Methods: Single-site prospective observational cohort study of infants who were intubated in a level 4 referral NICU between September 1, 2011 and November 30, 2013. A standardized pediatric airway registry was implemented to document patient, practice, and intubator characteristics and outcomes of intubation encounters. The primary outcome was adverse TIAEs.

Results: Adverse TIAEs occurred in 153 of 701 (22%) tracheal intubation encounters. Factors that were independently associated with lower incidence of TIAEs in logistic regression included attending physician (vs. resident; odds ratio (OR) 0.4, 95% CI: 0.16, 0.98) and use of paralytic medication (OR 0.45, 95% CI: 0.25, 0.81). Severe oxygen desaturations (≥ 20% decrease in oxygen saturation) occurred in 51.1% of encounters and were more common in tracheal intubations performed by residents (62.8%), compared to fellows (43.2%) or attendings (47.5%; p = 0.008).

Conclusions: Adverse TIAEs and severe oxygen desaturation events are common in the NICU setting. Modifiable risk factors associated with TIAEs identified include intubator training level and use of paralytic medications.

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Figures

Figure 1
Figure 1
Tracheal intubation (TI) encounters included in analysis *Includes laryngeal mask airway (LMA) and fiber optic flexible laryngoscope
Figure 2
Figure 2
Bar graph demonstrating proportion of tracheal intubation encounters with severe desaturation (≥20% decrease in SpO2) and any tracheal intubation associated event (TIAE). Results are shown for all encounters and separated by intubator training level. Desaturations: p=0.008, χ2 (2 d.f.) TIAE: p=0.045, attending (vs. resident) in multivariate logistic regression model including: training level, paralytic medications, small patient size, indication of ventilation failure, replacement of endotracheal tube, and history of difficulty airway
See this image and copyright information in PMC

References

    1. Nishisaki A, Turner DA, Brown CA, Walls RM, Nadkarni VM for the National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. A national emergency airway registry for children: Landscape of tracheal intubation in 15 PICUs. Crit Care Med. 2013;41:874–885. - PubMed
    1. Carroll CL, Spinella PC, Corsi JM, Stoltz P, Zucker AR. Emergent endotracheal intubations in children: Be careful if it's late when you intubate. Pediatr Crit Care Med. 2010;11:343–348. - PubMed
    1. Venkatesh V, Ponnusamy V, Anandaraj J, Chaudhary R, Malviya M, Clarke P, Arasu A, Curley A. Endotracheal intubation in a neonatal population remains associated with a high risk of adverse events. Eur J Pediatr. 2011;170:223–227. - PubMed
    1. Sanders RC, Giuliano JS, Sullivan JE, Brown CA, Walls RM, Nadkarni V, Nishisaki A for the National Emergency Airway Registry for Children Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network. Level of trainee and tracheal intubation outcomes. Pediatrics. 2013;131:e821–e828. - PubMed
    1. Simon L, Trifa M, Mokhtari M, Hamza J, Treluyer J-M. Premedication for tracheal intubation: A prospective survey in 75 neonatal and pediatric intensive care units. Crit Care Med. 2004;32:565–568. - PubMed

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