Foglia Elizabeth E, Ades Anne, Napolitano Natalie, Leffelman Jessica, Nadkarni Vinay, Nishisaki Akira
Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pa., USA.
Neonatology. 2015;108(1):23-9. doi: 10.1159/000381252. Epub 2015 May 6.
The incidence of adverse tracheal intubation-associated events (TIAEs) and associated patient, practice, and intubator characteristics in the neonatal intensive care unit (NICU) setting are unknown.
To determine the incidence of adverse TIAEs and to identify factors associated with TIAEs in the NICU.
Single-site prospective observational cohort study of infants who were intubated in a level 4 referral NICU between September 1, 2011 and November 30, 2013. A standardized pediatric airway registry was implemented to document patient, practice, and intubator characteristics and outcomes of intubation encounters. The primary outcome was adverse TIAEs.
Adverse TIAEs occurred in 153 of 701 (22%) tracheal intubation encounters. Factors that were independently associated with lower incidence of TIAEs in logistic regression included attending physician (vs. resident; odds ratio (OR) 0.4, 95% CI: 0.16, 0.98) and use of paralytic medication (OR 0.45, 95% CI: 0.25, 0.81). Severe oxygen desaturations (≥ 20% decrease in oxygen saturation) occurred in 51.1% of encounters and were more common in tracheal intubations performed by residents (62.8%), compared to fellows (43.2%) or attendings (47.5%; p = 0.008).
Adverse TIAEs and severe oxygen desaturation events are common in the NICU setting. Modifiable risk factors associated with TIAEs identified include intubator training level and use of paralytic medications.
新生儿重症监护病房（NICU）中气管插管相关不良事件（TIAEs）的发生率以及相关的患者、操作和插管人员特征尚不清楚。
确定NICU中不良TIAEs的发生率，并识别与TIAEs相关的因素。
对2011年9月1日至2013年11月30日期间在一家4级转诊NICU接受插管的婴儿进行单中心前瞻性观察队列研究。实施了标准化的儿科气道登记系统，以记录患者、操作和插管人员特征以及插管情况的结果。主要结局是不良TIAEs。
在701次气管插管中，有153次（22%）发生了不良TIAEs。在逻辑回归中，与较低TIAEs发生率独立相关的因素包括主治医生（与住院医生相比；优势比（OR）0.4，95%置信区间：0.16，0.98）和使用麻痹药物（OR 0.45，95%置信区间：0.25，0.81）。51.1%的插管出现严重氧饱和度下降（氧饱和度降低≥20%），住院医生进行的气管插管中更常见（62.8%），相比之下，专科住院医生为（43.2%），主治医生为（47.5%；p = 0.008）。
在NICU环境中，不良TIAEs和严重氧饱和度下降事件很常见。已确定的与TIAEs相关的可改变风险因素包括插管人员培训水平和麻痹药物的使用。
