Neonatal intubation performance: Room for improvement in tertiary neonatal intensive care units

Abstract Objective To describe neonatal tracheal intubation (TI) performance across five neonatal intensive care units. Methods This prospective descriptive study was conducted at five level III neonatal intensive care units (NICU) between July 2010 and July 2011. TI performance data were collected...

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Bibliographic Details
Published in:Resuscitation 2013-10, Vol.84 (10), p.1359-1364
Main Authors: Haubner, Laura Y, Barry, James S, Johnston, Lindsay C, Soghier, Lamia, Tatum, Philip M, Kessler, David, Downes, Katheryne, Auerbach, Marc
Format: Article
Language:English
Subjects:
Clinical Competence
Emergency
Graduate medical education
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Intubation
Intubation, Intratracheal - standards
Medical procedure
Neonatal intensive care unit
Neonates
Prospective Studies
Quality Improvement
Resident education
Tertiary Care Centers
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Summary:Abstract Objective To describe neonatal tracheal intubation (TI) performance across five neonatal intensive care units. Methods This prospective descriptive study was conducted at five level III neonatal intensive care units (NICU) between July 2010 and July 2011. TI performance data were collected using a standardized data collection instrument (provider, procedure, and patient characteristics) and analyzed using descriptive and inferential statistics. The primary outcome of interest was procedural success rate defined as a tube placed in the airway between the vocal cords that could be used to provide ventilation. Results Forty-four percent of 455 TI attempts (203 patients) were successful. Attending physicians and 3rd year neonatal fellows had the highest success rates; 72.2% and 70%, respectively. Pediatric residents had the lowest success rate (20.3%). The median duration of attempts was 30 s for residents, 25 s for fellows, and 20 s for neonatal attending physicians. The most common reasons cited for failure were inability to visualize the vocal cords (25%), patient decompensation (desaturation/bradycardia, 41%) and esophageal TI (19%). The duration of all TI attempts ranged from 5 s to 180 s and there was no difference between successful and failed attempts. Impending respiratory failure (46.5%) was the most common indication for TI. Patient factors (weight, gestational age, or number of previous TI attempts) were not associated with TI success. Conclusions Overall TI procedure success rates were poor. Providers with advanced training were more likely to be successful. Patient factors were not associated with TI success.
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2013.03.014