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.
journal_name
Neonatologyjournal_title
Neonatologyauthors
Foglia EE,Ades A,Napolitano N,Leffelman J,Nadkarni V,Nishisaki Adoi
10.1159/000381252subject
Has Abstractpub_date
2015-01-01 00:00:00pages
23-9issue
1eissn
1661-7800issn
1661-7819pii
000381252journal_volume
108pub_type
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