新生儿气管插管期间的团队压力和不良事件：来自 NEAR4NEOS 的报告。
Team Stress and Adverse Events during Neonatal Tracheal Intubations: A Report from NEAR4NEOS.
机构信息
Division of Neonatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington.
Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
出版信息
Am J Perinatol. 2020 Dec;37(14):1417-1424. doi: 10.1055/s-0039-1693698. Epub 2019 Jul 31.
OBJECTIVE
This study aimed to examine the association between team stress level and adverse tracheal intubation (TI)-associated events during neonatal intubations.
STUDY DESIGN
TIs from 10 academic neonatal intensive care units were analyzed. Team stress level was rated immediately after TI using a 7-point Likert scale (1 = high stress). Associations among team stress, adverse TI-associated events, and TI characteristics were evaluated.
RESULT
In this study, 208 of 2,009 TIs (10%) had high stress levels (score < 4). Oxygenation failure, hemodynamic instability, and family presence were associated with high stress level. Video laryngoscopy and premedication were associated with lower stress levels. High stress level TIs were associated with adverse TI-associated event rates (31 vs. 16%, < 0.001), which remained significant after adjusting for potential confounders including patient, provider, and practice factors associated with high stress (odds ratio: 1.90, 96% confidence interval: 1.36-2.67, < 0.001).
CONCLUSION
High team stress levels during TI were more frequently reported among TIs with adverse events.
目的
本研究旨在探讨团队压力水平与新生儿插管期间不良气管插管（TI）相关事件之间的关联。
研究设计
分析了 10 个学术性新生儿重症监护病房的 TI。使用 7 点 Likert 量表（1=高压力）在 TI 后立即对团队压力水平进行评分。评估团队压力、不良 TI 相关事件和 TI 特征之间的关联。
结果
在这项研究中，2009 次 TI 中有 208 次（10%）压力水平较高（评分<4）。氧合失败、血流动力学不稳定和家属在场与高压力水平相关。视频喉镜和预用药与较低的压力水平相关。高压力水平 TI 与不良 TI 相关事件发生率相关（31%与 16%，<0.001），在调整与高压力相关的患者、提供者和实践因素等潜在混杂因素后，这仍然具有统计学意义（比值比：1.90，96%置信区间：1.36-2.67，<0.001）。
结论
在 TI 期间，团队压力水平较高的情况在发生不良事件的 TI 中更为常见。
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