Tippmann Susanne, Haan Martin, Winter Julia, Mühler Ann-Kathrin, Schmitz Katharina, Schönfeld Mascha, Brado Luise, Mahmoudpour Seyed Hamidreza, Mildenberger Eva, Kidszun André
Division of Neonatology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Division of Medical Biostatistics and Bioinformatics, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Front Pediatr. 2021 May 11;9:675238. doi: 10.3389/fped.2021.675238. eCollection 2021.
Intubation of neonates is difficult and hazardous. Factors associated with procedure-related adverse events and unsuccessful intubation attempts are insufficiently evaluated, especially during neonatal nasotracheal intubations. Aim of this study was to determine the frequency of tracheal intubation-associated events (TIAEs) during neonatal nasotracheal intubations and to identify factors associated with TIAEs and unsuccessful intubation attempts in our neonatal unit. This was a prospective, single-site, observational study from May 2017 to November 2019, performed at a tertiary care neonatal intensive care unit in a German academic teaching hospital. All endotracheal intubation encounters performed by the neonatal team were recorded. Two hundred and fifty-eight consecutive intubation encounters in 197 patients were analyzed. One hundred and forty-eight (57.4%) intubation encounters were associated with at least one TIAE. Intubation inexperience (<10 intubation encounters) (OR = 2.15; 95% CI, 1.257-3.685) and equipment problems (OR = 3.43; 95% CI, 1.12-10.52) were predictive of TIAEs. Intubation at first attempt (OR = 0.10; 95% CI, 0.06-0.19) and videolaryngoscopy (OR = 0.47; 96% CI, 0.25-0.860) were predictive of intubation encounters without TIAEs. The first intubation attempt was commonly done by pediatric residents (67.8%). A median of two attempts were performed until successful intubation. Restricted laryngoscopic view (OR = 3.07; 95% CI, 2.08-4.53; Cormack-Lehane grade 2 vs. grade 1), intubation by pediatric residents when compared to neonatologists (OR = 1.74; 95% CI, 1.265-2.41) and support by less experienced neonatal nurses (OR = 1.60; 95% CI, 1.04-2.46) were associated with unsuccessful intubation attempts. In our unit, TIAEs and unsuccessful intubation attempts occurred frequently during neonatal nasotracheal intubations. To improve success rates, quality improvement und further research should target interprofessional education and training, equipment problems and videolaryngoscopy.
新生儿气管插管操作困难且具有危险性。与操作相关的不良事件及插管失败相关因素尚未得到充分评估，尤其是在新生儿鼻气管插管过程中。本研究的目的是确定新生儿鼻气管插管期间气管插管相关事件（TIAEs）的发生率，并识别我们新生儿病房中与TIAEs及插管失败相关的因素。这是一项于2017年5月至2019年11月在德国一所学术教学医院的三级护理新生儿重症监护病房进行的前瞻性、单中心观察性研究。记录了新生儿团队进行的所有气管插管情况。对197例患者的258次连续插管情况进行了分析。148次（57.4%）插管情况与至少一次TIAE相关。插管经验不足（<10次插管经历）（OR = 2.15；95% CI，1.257 - 3.685）和设备问题（OR = 3.43；95% CI，1.12 - 10.52）可预测TIAEs。首次尝试插管（OR = 0.10；95% CI，0.06 - 0.19）和视频喉镜检查（OR = 0.47；96% CI，0.25 - 0.860）可预测无TIAEs的插管情况。首次插管尝试通常由儿科住院医师完成（67.8%）。直至成功插管，平均进行了两次尝试。喉镜视野受限（OR = 3.07；95% CI，2.08 - 4.53；Cormack - Lehane分级2级与1级相比）、与新生儿科医生相比由儿科住院医师进行插管（OR = 1.74；95% CI，1.265 - 2.41）以及由经验不足的新生儿护士提供支持（OR = 1.60；95% CI，1.04 - 2.46）与插管失败相关。在我们的病房，新生儿鼻气管插管期间TIAEs和插管失败情况频繁发生。为提高成功率，质量改进及进一步研究应针对跨专业教育与培训、设备问题和视频喉镜检查。
