Neonatal Intubation Practice and Outcomes: An International Registry Study
Neonatal Intubation Practice and Outcomes: An International Registry Study
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DOI：
10.1542/peds.2018-0902
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发表时间：
2019-01-01
期刊：
影响因子：
8
通讯作者：
Nishisaki, Akira
中科院分区：
文献类型：
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作者：
Foglia, Elizabeth E.;Ades, Anne;Nishisaki, Akira
背景和注意事项：新生儿气管插管是一个关键但有潜在危险的过程。我们试图表征插管的做法和结果在新生儿重症监护病房和产房（DR）设置，并确定潜在的可修改的因素，以提高新生儿插管safety.METHODS：我们开发了国家紧急气道登记新生儿和收集标准化的数据，患者，供应商，做法和新生儿插管的结果。安全性结局包括不良气管插管相关事件（TIAE）和重度血氧饱和度下降（血氧饱和度下降20%）。我们研究插管特征和不良事件之间的关系，单变量检验和多变量logistic regression.RESULTS：我们从10个中心获得了2009例NICU插管和598例DR插管。儿科住院医师尝试了15%的NICU和2%的DR插管。在NICU，首次尝试成功率为49%，不良TIAE发生率为18%，严重氧饱和度下降率为48%。在DR中，46%的插管在第一次尝试时成功，TIAE发生率为17%，严重去氧饱和率为31%。部位特异性TIAE发生率范围为9%至50%（P <0.001），严重去氧饱和率范围为29%至69%（P = 0.001）。与减少新生儿重症监护室中TIAE独立相关的实践包括视频喉镜（调整后的比值比为0.46，95%置信区间为0.28-0.73）和麻痹前用药（调整后的比值比为0.38，95%置信区间为0.25-0.57）。结论：我们实施了一种新的多部位新生儿插管登记，并确定了与不良事件相关的潜在可修改因素。我们的研究结果将为未来的干预研究提供信息，以提高新生儿插管的安全性。
BACKGROUND AND OBJECTIVES: Neonatal tracheal intubation is a critical but potentially dangerous procedure. We sought to characterize intubation practice and outcomes in the NICU and delivery room (DR) settings and to identify potentially modifiable factors to improve neonatal intubation safety.METHODS: We developed the National Emergency Airway Registry for Neonates and collected standardized data for patients, providers, practices, and outcomes of neonatal intubation. Safety outcomes included adverse tracheal intubation-associated events (TIAEs) and severe oxygen desaturation (20% decline in oxygen saturation). We examined the relationship between intubation characteristics and adverse events with univariable tests and multivariable logistic regression.RESULTS: We captured 2009 NICU intubations and 598 DR intubations from 10 centers. Pediatric residents attempted 15% of NICU and 2% of DR intubations. In the NICU, the first attempt success rate was 49%, adverse TIAE rate was 18%, and severe desaturation rate was 48%. In the DR, 46% of intubations were successful on the first attempt, with 17% TIAE rate and 31% severe desaturation rate. Site-specific TIAE rates ranged from 9% to 50% (P < .001), and severe desaturation rates ranged from 29% to 69% (P = .001). Practices independently associated with reduced TIAEs in the NICU included video laryngoscope (adjusted odds ratio 0.46, 95% confidence interval 0.28-0.73) and paralytic premedication (adjusted odds ratio 0.38, 95% confidence interval 0.25-0.57).CONCLUSIONS: We implemented a novel multisite neonatal intubation registry and identified potentially modifiable factors associated with adverse events. Our results will inform future interventional studies to improve neonatal intubation safety.