Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: A report from the National Emergency Airway Registry for Neonates

Taylor Sawyer, Elizabeth E. Foglia, Anne Ades, Ahmed Moussa, Natalie Napolitano, Kristen Glass, Lindsay Johnston, Philipp Jung, Neetu Singh, Bin Huey Quek, James Barry, Jeanne Zenge, Stephen D. Demeo, Brianna Brei, Jeanne Krick, Jae H. Kim, Vinay Nadkarni, Akira Nishisaki

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective To determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU). Design Retrospective review of prospectively collected data on intubations performed in the NICU from the National Emergency Airway Registry for Neonates. Setting Ten academic NICUs. Patients Neonates intubated in the NICU at each of the sites between October 2014 and March 2017. Main outcome measures Difficult intubation was defined as one requiring three or more attempts by a non-resident provider. Patient (age, weight and bedside predictors of difficult intubation), practice (intubation method and medications used), provider (training level and profession) and outcome data (intubation attempts, adverse events and oxygen desaturations) were collected for each intubation. Results Out of 2009 tracheal intubations, 276 (14%) met the definition of difficult intubation. Difficult intubations were more common in neonates <32 weeks, <1500 g. The difficult intubation group had a 4.9 odds ratio (OR) for experiencing an adverse event and a 4.2 OR for severe oxygen desaturation. Bedside screening tests of difficult intubation lacked sensitivity (receiver operator curve 0.47-0.53). Conclusions Difficult intubations are common in the NICU and are associated with adverse event and severe oxygen desaturation. Difficult intubations occur more commonly in small preterm infants. The occurrence of a difficult intubation in other neonates is hard to predict due to the lack of sensitivity of bedside screening tests.

Original languageEnglish (US)
Pages (from-to)F461-F466
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume104
Issue number5
DOIs
StatePublished - Sep 1 2019

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Neonatal Intensive Care Units
Intubation
Registries
Emergencies
Newborn Infant
Incidence
Oxygen
Odds Ratio
Premature Infants

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Sawyer, Taylor ; Foglia, Elizabeth E. ; Ades, Anne ; Moussa, Ahmed ; Napolitano, Natalie ; Glass, Kristen ; Johnston, Lindsay ; Jung, Philipp ; Singh, Neetu ; Quek, Bin Huey ; Barry, James ; Zenge, Jeanne ; Demeo, Stephen D. ; Brei, Brianna ; Krick, Jeanne ; Kim, Jae H. ; Nadkarni, Vinay ; Nishisaki, Akira. / Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit : A report from the National Emergency Airway Registry for Neonates. In: Archives of Disease in Childhood: Fetal and Neonatal Edition. 2019 ; Vol. 104, No. 5. pp. F461-F466.
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title = "Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: A report from the National Emergency Airway Registry for Neonates",
abstract = "Objective To determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU). Design Retrospective review of prospectively collected data on intubations performed in the NICU from the National Emergency Airway Registry for Neonates. Setting Ten academic NICUs. Patients Neonates intubated in the NICU at each of the sites between October 2014 and March 2017. Main outcome measures Difficult intubation was defined as one requiring three or more attempts by a non-resident provider. Patient (age, weight and bedside predictors of difficult intubation), practice (intubation method and medications used), provider (training level and profession) and outcome data (intubation attempts, adverse events and oxygen desaturations) were collected for each intubation. Results Out of 2009 tracheal intubations, 276 (14{\%}) met the definition of difficult intubation. Difficult intubations were more common in neonates <32 weeks, <1500 g. The difficult intubation group had a 4.9 odds ratio (OR) for experiencing an adverse event and a 4.2 OR for severe oxygen desaturation. Bedside screening tests of difficult intubation lacked sensitivity (receiver operator curve 0.47-0.53). Conclusions Difficult intubations are common in the NICU and are associated with adverse event and severe oxygen desaturation. Difficult intubations occur more commonly in small preterm infants. The occurrence of a difficult intubation in other neonates is hard to predict due to the lack of sensitivity of bedside screening tests.",
author = "Taylor Sawyer and Foglia, {Elizabeth E.} and Anne Ades and Ahmed Moussa and Natalie Napolitano and Kristen Glass and Lindsay Johnston and Philipp Jung and Neetu Singh and Quek, {Bin Huey} and James Barry and Jeanne Zenge and Demeo, {Stephen D.} and Brianna Brei and Jeanne Krick and Kim, {Jae H.} and Vinay Nadkarni and Akira Nishisaki",
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Sawyer, T, Foglia, EE, Ades, A, Moussa, A, Napolitano, N, Glass, K, Johnston, L, Jung, P, Singh, N, Quek, BH, Barry, J, Zenge, J, Demeo, SD, Brei, B, Krick, J, Kim, JH, Nadkarni, V & Nishisaki, A 2019, 'Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit: A report from the National Emergency Airway Registry for Neonates', Archives of Disease in Childhood: Fetal and Neonatal Edition, vol. 104, no. 5, pp. F461-F466. https://doi.org/10.1136/archdischild-2018-316336

Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit : A report from the National Emergency Airway Registry for Neonates. / Sawyer, Taylor; Foglia, Elizabeth E.; Ades, Anne; Moussa, Ahmed; Napolitano, Natalie; Glass, Kristen; Johnston, Lindsay; Jung, Philipp; Singh, Neetu; Quek, Bin Huey; Barry, James; Zenge, Jeanne; Demeo, Stephen D.; Brei, Brianna; Krick, Jeanne; Kim, Jae H.; Nadkarni, Vinay; Nishisaki, Akira.

In: Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 104, No. 5, 01.09.2019, p. F461-F466.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidence, impact and indicators of difficult intubations in the neonatal intensive care unit

T2 - A report from the National Emergency Airway Registry for Neonates

AU - Sawyer, Taylor

AU - Foglia, Elizabeth E.

AU - Ades, Anne

AU - Moussa, Ahmed

AU - Napolitano, Natalie

AU - Glass, Kristen

AU - Johnston, Lindsay

AU - Jung, Philipp

AU - Singh, Neetu

AU - Quek, Bin Huey

AU - Barry, James

AU - Zenge, Jeanne

AU - Demeo, Stephen D.

AU - Brei, Brianna

AU - Krick, Jeanne

AU - Kim, Jae H.

AU - Nadkarni, Vinay

AU - Nishisaki, Akira

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Objective To determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU). Design Retrospective review of prospectively collected data on intubations performed in the NICU from the National Emergency Airway Registry for Neonates. Setting Ten academic NICUs. Patients Neonates intubated in the NICU at each of the sites between October 2014 and March 2017. Main outcome measures Difficult intubation was defined as one requiring three or more attempts by a non-resident provider. Patient (age, weight and bedside predictors of difficult intubation), practice (intubation method and medications used), provider (training level and profession) and outcome data (intubation attempts, adverse events and oxygen desaturations) were collected for each intubation. Results Out of 2009 tracheal intubations, 276 (14%) met the definition of difficult intubation. Difficult intubations were more common in neonates <32 weeks, <1500 g. The difficult intubation group had a 4.9 odds ratio (OR) for experiencing an adverse event and a 4.2 OR for severe oxygen desaturation. Bedside screening tests of difficult intubation lacked sensitivity (receiver operator curve 0.47-0.53). Conclusions Difficult intubations are common in the NICU and are associated with adverse event and severe oxygen desaturation. Difficult intubations occur more commonly in small preterm infants. The occurrence of a difficult intubation in other neonates is hard to predict due to the lack of sensitivity of bedside screening tests.

AB - Objective To determine the incidence, indicators and clinical impact of difficult tracheal intubations in the neonatal intensive care unit (NICU). Design Retrospective review of prospectively collected data on intubations performed in the NICU from the National Emergency Airway Registry for Neonates. Setting Ten academic NICUs. Patients Neonates intubated in the NICU at each of the sites between October 2014 and March 2017. Main outcome measures Difficult intubation was defined as one requiring three or more attempts by a non-resident provider. Patient (age, weight and bedside predictors of difficult intubation), practice (intubation method and medications used), provider (training level and profession) and outcome data (intubation attempts, adverse events and oxygen desaturations) were collected for each intubation. Results Out of 2009 tracheal intubations, 276 (14%) met the definition of difficult intubation. Difficult intubations were more common in neonates <32 weeks, <1500 g. The difficult intubation group had a 4.9 odds ratio (OR) for experiencing an adverse event and a 4.2 OR for severe oxygen desaturation. Bedside screening tests of difficult intubation lacked sensitivity (receiver operator curve 0.47-0.53). Conclusions Difficult intubations are common in the NICU and are associated with adverse event and severe oxygen desaturation. Difficult intubations occur more commonly in small preterm infants. The occurrence of a difficult intubation in other neonates is hard to predict due to the lack of sensitivity of bedside screening tests.

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