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Shay R, Weikel BW, Mascorro M, Harding E, Beard L, Grover T, Barry JS. Continuous improvement of non-emergent neonatal intubations in a level IV NICU. J Perinatol 2024:10.1038/s41372-024-02062-7. [PMID: 39025954 DOI: 10.1038/s41372-024-02062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE We sought to improve practices and outcomes related to non-emergent neonatal intubations in a level IV academic Neonatal Intensive Care Unit. STUDY DESIGN A multidisciplinary team created guidelines for non-emergent neonatal intubations. In period 1, premedication practices were standardized. In period 2, paralytic use and video laryngoscope use were recommended. Premedication and video laryngoscopy practices were assessed along with number of intubation attempts and frequency of bradycardia and desaturation. RESULTS 636 intubations performed by neonatology fellows and neonatal advanced practice providers were reviewed over six academic years. Two academic years were included in each of the following study periods: baseline, period 1, and period 2. In our unit, compliance with recommended premedication practices and administration of paralytic medication has increased considerably, and video laryngoscopy is now utilized in most of our procedures. The frequency of intubation success on the first attempt has increased, and the frequency of both bradycardia and desaturation during intubation has decreased. In our analysis, paralytic use (AOR 2.41, 95 CI (1.53, 3.81)) and the combination of paralytic and video laryngoscopy (AOR 4.07, 95 CI (2.09, 7.92)) are associated with increased odds of intubating successfully on the first attempt. CONCLUSIONS This initiative increased the use of standardized premedication, paralytic medication and video laryngoscopy for non-emergent neonatal intubations with temporally associated improvement in patient outcomes including fewer intubation attempts and reduction in physiologic instability.
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Affiliation(s)
- Rebecca Shay
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO, USA.
- Children's Hospital Colorado, Section of Neonatology, Aurora, CO, USA.
| | - Blair W Weikel
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO, USA
- Children's Hospital Colorado, Section of Neonatology, Aurora, CO, USA
| | - Melanie Mascorro
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO, USA
- Children's Hospital Colorado, Section of Neonatology, Aurora, CO, USA
| | - Emma Harding
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO, USA
- Children's Hospital Colorado, Section of Neonatology, Aurora, CO, USA
| | - Lauren Beard
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO, USA
- Children's Hospital Colorado, Section of Neonatology, Aurora, CO, USA
| | - Theresa Grover
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO, USA
- Children's Hospital Colorado, Section of Neonatology, Aurora, CO, USA
| | - James S Barry
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO, USA
- Children's Hospital Colorado, Section of Neonatology, Aurora, CO, USA
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Pinheiro JMB. Neonatal Airway Management. CHILDREN (BASEL, SWITZERLAND) 2024; 11:82. [PMID: 38255395 PMCID: PMC10814596 DOI: 10.3390/children11010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
The neonatal airway is often difficult to secure, whether the practitioner responsible for managing the airway is a neonatologist, pediatrician, anesthesiologist, another specialist or an advanced practice provider [...].
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Affiliation(s)
- Joaquim M B Pinheiro
- Division of Neonatology, Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA
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Neches SK, DeMartino C, Shay R. Pharmacologic Adjuncts for Neonatal Tracheal Intubation: The Evidence Behind Premedication. Neoreviews 2023; 24:e783-e796. [PMID: 38036442 DOI: 10.1542/neo.24-12-e783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Premedication such as analgesia, sedation, vagolytics, and paralytics may improve neonatal tracheal intubation success, reduce intubation-associated adverse events, and create optimal conditions for performing this high-risk and challenging procedure. Although rapid sequence induction including a paralytic agent has been adopted for intubations in pediatric and adult critical care, neonatal clinical practice varies. This review aims to summarize details of common classes of neonatal intubation premedication including indications for use, medication route, dosage, potential adverse effects in term and preterm infants, and reversal agents. In addition, this review shares the literature on national and international practice variations; explores evidence in support of establishing premedication guidelines; and discusses unique circumstances in which premedication use has not been established, such as during catheter-based or minimally invasive surfactant delivery. With increasing survival of extremely preterm infants, clear guidance for premedication use in this population will be necessary, particularly considering potential short- and long-term side effects of procedural sedation on the developing brain.
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Affiliation(s)
- Sara K Neches
- Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - Cassandra DeMartino
- Department of Pediatrics, Division of Neonatology, Yale New Haven Hospital, New Haven, CT
| | - Rebecca Shay
- Department of Pediatrics, Division of Neonatology, University of Colorado School of Medicine and Children's Hospital of Colorado, Denver, CO
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Yousef N, Soghier L. Neonatal airway management training using simulation-based educational methods and technology. Semin Perinatol 2023; 47:151822. [PMID: 37778883 DOI: 10.1016/j.semperi.2023.151822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Airway management is a fundamental component of neonatal critical care and requires a high level of skill. Neonatal endotracheal intubation (ETI), bag-mask ventilation, and supraglottic airway management are complex technical skills to acquire and continually maintain. Simulation training has emerged as a leading educational modality to accelerate the acquisition of airway management skills and train interprofessional teams. However, current simulation-based training does not always replicate neonatal airway management needed for patient care with a high level of fidelity. Educators still rely on clinical training on live patients. In this article, we will a) review the importance of simulation-based neonatal airway training for learners and clinicians, b) evaluate the available training modalities, instructional design, and challenges for airway procedural skill acquisition, especially neonatal ETI, and c) describe the human factors affecting the transfer of airway training skills into the clinical environment.
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Affiliation(s)
- Nadya Yousef
- Division of Pediatrics and Neonatal Critical Care, "A. Béclère" Medical Center, Paris-Saclay University Hospitals, APHP, Paris, France
| | - Lamia Soghier
- Children's National Hospital, Washington, DC, United States; The George Washington University School of Medicine and Health Sciences, United States.
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