Presenter Status
Resident/Psychology Intern
Abstract Type
QI
Primary Mentor
Dr. Emily McNellis
Start Date
4-5-2022 12:30 PM
End Date
4-5-2022 12:45 PM
Presentation Type
Oral Presentation
Description
Background: The use of pre-medication for elective non-emergent intubation in neonates and infants has been suggested to minimize physiologic instability, decrease oral/pharyngeal trauma and decrease time and attempts to successful intubation. A pre-medication algorithm including the use of Fentanyl + Atropine was modified to include a higher dose of fentanyl with addition of muscle relaxant and benzodiazepine in a level IV neonatal intensive care unit.
Objective: The objective of this study was to compare first attempt success of intubation pre- vs post-modification of the pre-medication algorithm.
Methods: This is a single site retrospective chart review. Data were collected on patients ages 0 days to 12 months admitted and undergoing non-emergent endotracheal intubation in the Children’s Mercy Hospital Intensive Care Nursery (ICN) between January 1, 2015-March 31, 2019. Patients were excluded if intubation was performed by personnel other than ICN providers. Data were analyzed using the Chi Square and Cochran-Mantel-Haenszel tests for discreet / continuous and ordered variables respectively.
Results: 151 patients were identified with a total of 239 non-emergent, pre-medicated intubation events occurring during the study period. There were no differences in post-menstrual age (p=0.659), weight at intubation (p=0.921) or gender (p=0.773) between the two groups. There were more airway anomalies (12.4% vs 4.1%, p=0.009), more intubation events during 1st week of life (51.5% vs 39.2%, p=0.005) and more 1st attempts by neonatal fellows (52.1% vs 38%, p=
Conclusion: Compliance with the algorithm and use of muscle relaxants improved post-modification but did not affect overall first attempt success. A higher number of first attempts by trainees may have influenced the first attempt success rate post-modification.
Additional Files
Evaluation of a modified pre-medication algorithm for non-emergent intubation in a neonatal intensive care unit.pdf (112 kB)Abstract
Evaluation of a modified pre-medication algorithm for non-emergent intubation in a neonatal intensive care unit
Background: The use of pre-medication for elective non-emergent intubation in neonates and infants has been suggested to minimize physiologic instability, decrease oral/pharyngeal trauma and decrease time and attempts to successful intubation. A pre-medication algorithm including the use of Fentanyl + Atropine was modified to include a higher dose of fentanyl with addition of muscle relaxant and benzodiazepine in a level IV neonatal intensive care unit.
Objective: The objective of this study was to compare first attempt success of intubation pre- vs post-modification of the pre-medication algorithm.
Methods: This is a single site retrospective chart review. Data were collected on patients ages 0 days to 12 months admitted and undergoing non-emergent endotracheal intubation in the Children’s Mercy Hospital Intensive Care Nursery (ICN) between January 1, 2015-March 31, 2019. Patients were excluded if intubation was performed by personnel other than ICN providers. Data were analyzed using the Chi Square and Cochran-Mantel-Haenszel tests for discreet / continuous and ordered variables respectively.
Results: 151 patients were identified with a total of 239 non-emergent, pre-medicated intubation events occurring during the study period. There were no differences in post-menstrual age (p=0.659), weight at intubation (p=0.921) or gender (p=0.773) between the two groups. There were more airway anomalies (12.4% vs 4.1%, p=0.009), more intubation events during 1st week of life (51.5% vs 39.2%, p=0.005) and more 1st attempts by neonatal fellows (52.1% vs 38%, p=
Conclusion: Compliance with the algorithm and use of muscle relaxants improved post-modification but did not affect overall first attempt success. A higher number of first attempts by trainees may have influenced the first attempt success rate post-modification.
