Difficult tracheal intubation in neonates and infants. NEonate
and Children audiT of Anaesthesia pRactice IN Europe
(NECTARINE): a prospective European multicentre observational
study.

J 2021

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study.

DISMA, Nicola, Katalin VIRAG, Thomas RIVA, Jost KAUFMANN, Thomas ENGELHARDT et. al.

Basic information

Original name

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study.

Authors

Edition

British journal of anaesthesia, Elsevier Ltd. 2021, 1471-6771

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

Impact factor

Impact factor: 11.719

DOI

http://dx.doi.org/10.1016/j.bja.2021.02.021

Keywords in English

airways; anaesthesia; difficult intubation; infants; morbidity; mortality; neonates; paediatric

Abstract

V originále

Abstract BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1-6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event.

Citovat

DISMA, Nicola, Katalin VIRAG, Thomas RIVA, Jost KAUFMANN, Thomas ENGELHARDT, Walid HABRE, Yvona SEDLACKOVA, Lenka KNOPPOVA, Alena KVĚTOŇOVÁ, Martin VAVŘINA, Jiří ŽUREK and NECTARINE STUDY GROUP. Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study. British journal of anaesthesia. Elsevier Ltd., 2021. ISSN 1471-6771. Available from: https://dx.doi.org/10.1016/j.bja.2021.02.021.

@article{1761221,
   author = {Disma, Nicola and Virag, Katalin and Riva, Thomas and Kaufmann, Jost and Engelhardt, Thomas and Habre, Walid and Sedlackova, Yvona and Knoppova, Lenka and Květoňová, Alena and Vavřina, Martin and Žurek, Jiří and NECTARINE Study Group, },
   doi = {http://dx.doi.org/10.1016/j.bja.2021.02.021},
   keywords = {airways; anaesthesia; difficult intubation; infants; morbidity; mortality; neonates; paediatric},
   language = {eng},
   issn = {1471-6771},
   journal = {British journal of anaesthesia},
   title = {Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study.},
   year = {2021}
}

TY  - JOUR
ID  - 1761221
AU  - Disma, Nicola - Virag, Katalin - Riva, Thomas - Kaufmann, Jost - Engelhardt, Thomas - Habre, Walid - Sedlackova, Yvona - Knoppova, Lenka - Květoňová, Alena - Vavřina, Martin - Žurek, Jiří - NECTARINE Study Group,
PY  - 2021
TI  - Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study.
JF  - British journal of anaesthesia
PB  - Elsevier Ltd.
SN  - 14716771
KW  - airways
KW  - anaesthesia
KW  - difficult intubation
KW  - infants
KW  - morbidity
KW  - mortality
KW  - neonates
KW  - paediatric
N2  - Abstract BACKGROUND: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. METHODS: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. RESULTS: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1-6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. CONCLUSIONS: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event.
ER  -

DISMA, Nicola, Katalin VIRAG, Thomas RIVA, Jost KAUFMANN, Thomas ENGELHARDT, Walid HABRE, Yvona SEDLACKOVA, Lenka KNOPPOVA, Alena KVĚTOŇOVÁ, Martin VAVŘINA, Jiří ŽUREK and NECTARINE STUDY GROUP. Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study. \textit{British journal of anaesthesia}. Elsevier Ltd., 2021. ISSN~1471-6771. Available from: https://dx.doi.org/10.1016/j.bja.2021.02.021.

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