Apneic Oxygenation to Prevent Oxygen Desaturation During Intubation in the NICU

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Tracheal Intubation (TI) is a common, life-saving, high-risk procedure for critically ill infants. Adverse events occur in 18% of tracheal intubations performed in the NICU setting, and almost half (48%) of NICU intubations are complicated by severe oxygen desaturation (≥20% decline in pulse oximetry saturation [SpO2]). Severe desaturation is now recognized as an important contributor to neonatal morbidity and impaired neurodevelopmental outcomes. While modifiable factors have been identified that prevent adverse tracheal intubation associated events, there are limited interventions that consistently prevent severe oxygen desaturation during intubation in NICU patients. Typical practice during intubation in the NICU setting is to remove respiratory support during laryngoscopy and tracheal intubation attempts. Patients are often apneic during this period due to pre-medication administration, a practice that is recommended by the American Academy of Pediatrics. Apneic oxygenation is a strategy in which free flowing oxygen is provided via nasal cannula during laryngoscopy and tracheal intubation. Apneic oxygenation has been demonstrated to prevent or delay oxygen desaturation during intubation in adults and older children. To date, no published studies have systematically assessed the impact of apneic oxygenation during intubation for infants in the NICU setting. In this R21 application we propose a pilot randomized trial of infants ≥28 weeks corrected gestational age who undergo tracheal intubation in the NICU setting to determine if apneic oxygenation, compared with no respiratory support or oxygen during laryngoscopy and tracheal intubation attempt, reduces the magnitude of decline in oxygen saturation during tracheal intubation.