新生儿插管实践与结果：一项国际注册研究。
Neonatal Intubation Practice and Outcomes: An International Registry Study.
机构信息
Division of Neonatology, Department of Pediatrics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
Division of Neonatology, Department of Pediatrics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Pediatrics. 2019 Jan;143(1). doi: 10.1542/peds.2018-0902. Epub 2018 Dec 11.
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% ( < .001), and severe desaturation rates ranged from 29% to 69% ( = .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.
背景与目的
新生儿气管插管是一项关键但潜在危险的操作。我们旨在描述新生儿重症监护病房（NICU）和产房（DR）环境中的插管实践和结果，并确定潜在可改变的因素以提高新生儿插管安全性。
方法
我们开发了国家新生儿紧急气道登记处，并为患者、提供者、操作和新生儿插管结果收集了标准化数据。安全结果包括不良气管插管相关事件（TIAE）和严重氧饱和度下降（氧饱和度下降≥20%）。我们使用单变量检验和多变量逻辑回归检查了插管特征与不良事件之间的关系。
结果
我们从 10 个中心捕获了 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 中，首次尝试成功率为 49%，不良 TIAE 发生率为 18%，严重低氧血症发生率为 48%。在 DR 中，46%的插管在第一次尝试时成功，TIAE 发生率为 17%，严重低氧血症发生率为 31%。特定部位的 TIAE 发生率从 9%到 50%不等（<0.001），严重低氧血症发生率从 29%到 69%不等（=0.001）。与 NICU 中 TIAE 减少相关的独立操作因素包括视频喉镜（调整后的优势比 0.46，95%置信区间 0.28-0.73）和麻痹性预给药（调整后的优势比 0.38，95%置信区间 0.25-0.57）。
结论
我们实施了一项新的多站点新生儿插管登记处，并确定了与不良事件相关的潜在可改变因素。我们的结果将为未来提高新生儿插管安全性的干预性研究提供信息。
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