Original ArticleEndotracheal Intubation in Neonates: A Prospective Study of Adverse Safety Events in 162 Infants
Section snippets
Methods
We conducted a prospective, observational study in the 100-bed, academic, level IV (regional) NICU of the Vanderbilt University Medical Center. Endotracheal intubations are performed by pediatric residents, neonatal fellows, neonatal nurse practitioners/hospitalists, neonatologists, anesthesiologists, and otolaryngologists. Premedication for intubation was commonly used and consisted of an opiate and a benzodiazepine, though no formal protocol existed at the time of this study. The Vanderbilt
Results
During the 10-month study period, clinicians performed 304 endotracheal intubation encounters in 178 infants, an average of 1 intubation encounter per day. All intubations were performed orally, and no intubation encounter required more than 1 course. Adverse event data were available for 273 intubation encounters (90%) in 162 patients. One or more adverse events occurred in 107 of 273 intubations (39%). Nonsevere and severe events occurred in 96 (35%) and 24 (8.8%) intubations, respectively (
Discussion
We report that adverse events associated with endotracheal intubation in a large academic NICU were common, occurring in 4 of 10 intubations. Emergent intubations are associated with more than 4-fold increased odds of an adverse event. The most common cause for an emergent intubation in our cohort was unplanned extubation. In addition, higher numbers of intubation attempts were associated with increasing rates of adverse events, with each additional attempt doubling the odds of an adverse event.
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Cited by (0)
Use of the Research Electronic Data Capture program was supported by National Center for Advancing Translational Sciences/National Institutes of Health (NIH; UL1 TR000445). L.H. was supported by the NIH (5T32HD068256-02) and the John and Leslie Hooper Neonatal-Perinatal Endowment Fund. The authors declare no conflicts of interest.