极早产儿多次气管插管尝试与临床结局的关联：一项回顾性单中心队列研究
Association of multiple tracheal intubation attempts with clinical outcomes in extremely preterm infants: a retrospective single-center cohort study.
作者信息
Miller Kathleen E, Singh Neetu
机构信息
Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Department of Pediatrics, Children's Hospital at Dartmouth, Lebanon, NH, USA.
出版信息
J Perinatol. 2022 Sep;42(9):1216-1220. doi: 10.1038/s41372-022-01406-5. Epub 2022 Apr 26.
OBJECTIVE
We examined the association between the number of tracheal intubation (TI) attempts and clinical outcomes in extremely preterm infants.
METHOD
This is a single-center retrospective cohort study examining infants born at ≤28 weeks gestation intubated within the first four postnatal days. We analyzed infant, provider, and practice characteristics and clinical outcomes by exposure groups (1 vs. 2 vs. ≥3 TI attempts). Primary outcomes were death prior to NICU discharge or severe intraventricular hemorrhage (IVH).
RESULT
Ninety-nine infants were included. 46.5% required one TI attempt, 29.3% required two, and 24.2% required three or more. Increasing attempts was significantly associated with death (p = 0.004), adverse tracheal intubation-associated events (TIAEs; p = 0.004), and the training level of the first attempt provider (p = 0.002). No association was found with severe IVH or complications of prematurity.
CONCLUSIONS
Increasing attempts was associated with death and adverse TIAEs. Careful selection of providers could decrease adverse TIAEs and improve outcomes.
目的
我们研究了极早产儿气管插管（TI）尝试次数与临床结局之间的关联。
方法
这是一项单中心回顾性队列研究，研究对象为出生时孕周≤28周且在出生后前4天内接受气管插管的婴儿。我们按暴露组（1次TI尝试与2次TI尝试与≥3次TI尝试）分析了婴儿、提供者和实践特征以及临床结局。主要结局为新生儿重症监护病房（NICU）出院前死亡或重度脑室内出血（IVH）。
结果
纳入99例婴儿。46.5%的婴儿需要1次TI尝试，29.3%需要2次，24.2%需要3次或更多次。尝试次数增加与死亡（p = 0.004）、气管插管相关不良事件（TIAEs；p = 0.004）以及首次尝试提供者的培训水平（p = 0.002）显著相关。未发现与重度IVH或早产并发症有关联。
结论
尝试次数增加与死亡和不良TIAEs相关。仔细选择提供者可减少不良TIAEs并改善结局。
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