Submitting/Presenting Author

Lilah Melzer, Children's Mercy HospitalFollow

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

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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.

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May 4th, 12:30 PM May 4th, 12:45 PM

Evaluation of a modified pre-medication algorithm for non-emergent intubation in a neonatal intensive care unit

Watch recording of live event

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.