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Apneic Oxygenation to Prevent Oxygen Desaturation During Intubation in the NICU

窒息供氧以防止 NICU 插管期间氧饱和度下降

基本信息

批准号：
10570957
负责人：
Elizabeth Foglia
金额：
$ 21.43万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-02-11 至 2025-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10570957
关键词：
Academy Accident and Emergency department Adherence Adult Adverse event Air American Blood gas Cannulas Cardiopulmonary Resuscitation Caring Child Childhood Complex Control Groups Critical Illness Data Development Emergency Situation Ensure Evaluation Event Funding Future Gestational Age Heart Rate Human Hyperoxia Hypoxia Infant Informed Consent Intensive Care Units Intervention Intervention Studies Intratracheal Intubation Intubation Investigation Knowledge Laryngoscopy Life Lung Masks Methodology Methods Multicenter Studies National Institute of Child Health and Human Development Neonatal Neonatal Intensive Care Units Neurodevelopmental Impairment Nose Operating Rooms Outcome Oxygen Patients Pediatrics Pennsylvania Performance Phase Physiology Population Premedication Procedures Process Process Assessment Protocols documentation Publishing Pulse Oximetry Randomized Randomized, Controlled Trials Recommendation Regimen Registries Research Risk Running Safety Secondary to Site Time Titrations Trauma Universities Video Recording adverse outcome arm clinical practice design experience group intervention high risk improved medication administration neonatal morbidity novel pediatric patients performance site prevent primary outcome prospective randomized trial respiratory routine provider safety outcomes secondary outcome success supplemental oxygen tool treatment arm ventilation

项目摘要

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.

气管插管（TI）是一种常见的，挽救生命的，高风险的程序危重婴儿。在NICU环境中进行的气管插管中，18%发生不良事件， (48%）的NICU插管并发严重氧饱和度下降（脉搏血氧饱和度[SpO2]）。严重的去饱和现在被认为是一个重要的导致新生儿发病率和神经发育结果受损。虽然可以修改，已经确定了预防气管插管不良相关事件的因素，有限的干预措施，始终防止插管期间严重的氧饱和度下降， NICU患者在NICU环境中插管期间的典型做法是在插管期间移除呼吸支持。喉镜检查和气管插管尝试在此期间，患者通常会出现呼吸暂停，给药前管理，这是由美国科学院推荐的做法，儿科. 呼吸暂停氧合是一种策略，其中通过鼻腔提供自由流动的氧气，在喉镜检查和气管插管过程中插管。已证实窒息性氧合预防或延迟成人和年龄较大儿童插管期间的氧饱和度下降。至今没有已发表的研究系统地评估了插管期间呼吸暂停氧合的影响对于新生儿重症监护室的婴儿来说在这项R21申请中，我们提出了一项试点随机试验，在NICU接受气管插管的校正胎龄≥28周的婴儿设置，以确定是否呼吸暂停氧合，与无呼吸支持或氧气，喉镜检查和气管插管尝试，减少了血氧饱和度下降的幅度在气管插管的时候。