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. 2017 Jun 22;6(6):CD011791.
doi: 10.1002/14651858.CD011791.pub2.

Orotracheal intubation in infants performed with a stylet versus without a stylet

Joyce E O'Shea  1 , Jennifer O'Gorman, Aakriti Gupta, Sanjay Sinhal, Jann P Foster, Liam Af O'Connell, C Omar F Kamlin, Peter G Davis
Affiliations

Orotracheal intubation in infants performed with a stylet versus without a stylet

Joyce E O'Shea et al. Cochrane Database Syst Rev. .

Abstract

Background: Neonatal endotracheal intubation is a common and potentially life-saving intervention. It is a mandatory skill for neonatal trainees, but one that is difficult to master and maintain. Intubation opportunities for trainees are decreasing and success rates are subsequently falling. Use of a stylet may aid intubation and improve success. However, the potential for associated harm must be considered.

Objectives: To compare the benefits and harms of neonatal orotracheal intubation with a stylet versus neonatal orotracheal intubation without a stylet.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and previous reviews. We also searched cross-references, contacted expert informants, handsearched journals, and looked at conference proceedings. We searched clinical trials registries for current and recently completed trials. We conducted our most recent search in April 2017.

Selection criteria: All randomised, quasi-randomised, and cluster-randomised controlled trials comparing use versus non-use of a stylet in neonatal orotracheal intubation.

Data collection and analysis: Two review authors independently assessed results of searches against predetermined criteria for inclusion, assessed risk of bias, and extracted data. We used the standard methods of the Cochrane Collaboration, as documented in the Cochrane Handbook for Systemic Reviews of Interventions, and of the Cochrane Neonatal Review Group.

Main results: We included a single-centre non-blinded randomised controlled trial that reported a total of 302 intubation attempts in 232 infants. The median gestational age of enrolled infants was 29 weeks. Paediatric residents and fellows performed the intubations. We judged the study to be at low risk of bias overall. Investigators compared success rates of first-attempt intubation with and without use of a stylet and reported success rates as similar between stylet and no-stylet groups (57% and 53%) (P = 0.47). Success rates did not differ between groups in subgroup analyses by provider level of training and infant weight. Results showed no differences in secondary review outcomes, including duration of intubation, number of attempts, participant instability during the procedure, and local airway trauma. Only 25% of all intubations took less than 30 seconds to perform. Study authors did not report neonatal morbidity nor mortality. We considered the quality of evidence as low on GRADE analysis, given that we identified only one unblinded study.

Authors' conclusions: Current available evidence suggests that use of a stylet during neonatal orotracheal intubation does not significantly improve the success rate among paediatric trainees. However, only one brand of stylet and one brand of endotracheal tube have been tested, and researchers performed all intubations on infants in a hospital setting. Therefore, our results cannot be generalised beyond these limitations.

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Conflict of interest statement

Joyce O'Shea: nothing to declare. Jennifer O'Gorman: nothing to declare. Aakriti Gupta: nothing to declare. Sanjay Sinhal: nothing to declare. Jann Foster: nothing to declare. Liam O'Connell: co‐investigator on a trial that was eligible for inclusion in this review. Camille Omar Farouk Kamlin: co‐investigator on a trial that was eligible for inclusion in this review. Peter Davis: co‐investigator on a trial that was eligible for inclusion in this review.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 First intubation attempt success rate with use of stylet versus non‐use of stylet, outcome: 1.1 First intubation attempt success rate.
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5
Forest plot of comparison: 2 Intubation success: Professional category, outcome: 2.1 Fellow: first intubation attempt success rate.
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6
Forest plot of comparison: 2 Intubation success: Professional category, outcome: 2.2 Resident: first intubation attempt success rate.
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7
Forest plot of comparison: 3 Intubation success: use of premedication, outcome: 3.1 Intubations without premedication given to the infant.
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8
Forest plot of comparison: 3 Intubation success: use of premedication, outcome: 3.2 Intubations following premedication given to the infant.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD011791

References

References to studies included in this review

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