TY - JOUR
T1 - Success and safety of neonatal endotracheal tube exchanges
T2 - a NEAR4NEOS multicentre retrospective cohort study
AU - Miller, Kathleen
AU - Pouppirt, Nicole
AU - Wildenhain, Paul
AU - Abou Mehrem, Ayman
AU - Brajkovic, Ivana
AU - Demartino, Cassandra
AU - Glass, Kristen
AU - Hodgson, Kate Alison
AU - Jung, Philipp
AU - Moussa, Ahmed
AU - Pula-Dumitrescu, Mihai
AU - Quek, Binhuey
AU - Rumpel, Jennifer
AU - Shay, Rebecca
AU - Tingay, David
AU - Tyler, Michelle D.
AU - Unrau, Jennifer
AU - Wagner, Michael
AU - Shults, Justine
AU - Nishisaki, Akira
AU - Foglia, Elizabeth E.
AU - Herrick, Heidi M.
N1 - Publisher Copyright:
© 2025 Author(s) (or their employer(s)). No commercial re-use. See rights and permissions. Published by BMJ Group.
PY - 2025
Y1 - 2025
N2 - Objectives: To compare success and safety of endotracheal tube (ETT) exchanges with primary intubations and identify factors associated with ETT exchange outcomes. Design: Retrospective observational study of prospectively collected National Emergency Airway Registry for Neonates data. ETT exchanges are the placement of a new ETT when one is already in place, whereas primary intubations do not have a pre-existing ETT. The primary outcome was first-attempt success. Secondary outcomes included number of attempts, adverse tracheal intubation-associated events (TIAEs), severe TIAEs, desaturation and bradycardia. Descriptive statistics compared characteristics for ETT exchanges and primary intubations. Univariable and multivariable analyses compared primary and secondary outcomes and identified factors independently associated with ETT exchange outcomes. Results: A total of 1572 ETT exchanges and 9999 primary intubations across 21 sites were included from October 2014 to September 2022. ETT exchanges represented 2.3%-31.2% (mean 13.6%) of intubations across sites. Patient, provider and practice characteristics varied significantly between ETT exchanges and primary intubations. In univariable analyses, ETT exchanges were associated with higher first-attempt success (70.5% vs 53.6%; p<0.001) and fewer safety events. In multivariable analyses, ETT exchanges were associated with an increased adjusted OR (aOR) of first-attempt success (1.71; 95% CI 1.57 to 1.86; p<0.001). ETT exchanges were associated with lower aOR of all safety outcomes except severe TIAEs. Factors independently associated with ETT exchange first-attempt success included video laryngoscopy and paralytic premedication. Conclusion: Compared with primary intubations, ETT exchanges were associated with higher first-attempt success and fewer safety events. Video laryngoscope and paralytic premedication were associated with improved ETT exchange outcomes.
AB - Objectives: To compare success and safety of endotracheal tube (ETT) exchanges with primary intubations and identify factors associated with ETT exchange outcomes. Design: Retrospective observational study of prospectively collected National Emergency Airway Registry for Neonates data. ETT exchanges are the placement of a new ETT when one is already in place, whereas primary intubations do not have a pre-existing ETT. The primary outcome was first-attempt success. Secondary outcomes included number of attempts, adverse tracheal intubation-associated events (TIAEs), severe TIAEs, desaturation and bradycardia. Descriptive statistics compared characteristics for ETT exchanges and primary intubations. Univariable and multivariable analyses compared primary and secondary outcomes and identified factors independently associated with ETT exchange outcomes. Results: A total of 1572 ETT exchanges and 9999 primary intubations across 21 sites were included from October 2014 to September 2022. ETT exchanges represented 2.3%-31.2% (mean 13.6%) of intubations across sites. Patient, provider and practice characteristics varied significantly between ETT exchanges and primary intubations. In univariable analyses, ETT exchanges were associated with higher first-attempt success (70.5% vs 53.6%; p<0.001) and fewer safety events. In multivariable analyses, ETT exchanges were associated with an increased adjusted OR (aOR) of first-attempt success (1.71; 95% CI 1.57 to 1.86; p<0.001). ETT exchanges were associated with lower aOR of all safety outcomes except severe TIAEs. Factors independently associated with ETT exchange first-attempt success included video laryngoscopy and paralytic premedication. Conclusion: Compared with primary intubations, ETT exchanges were associated with higher first-attempt success and fewer safety events. Video laryngoscope and paralytic premedication were associated with improved ETT exchange outcomes.
KW - Intensive Care Units, Neonatal
KW - Neonatology
KW - Resuscitation
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UR - http://www.scopus.com/inward/citedby.url?scp=85217763190&partnerID=8YFLogxK
U2 - 10.1136/archdischild-2024-328287
DO - 10.1136/archdischild-2024-328287
M3 - Article
C2 - 39922689
AN - SCOPUS:85217763190
SN - 1359-2998
JO - Archives of Disease in Childhood: Fetal and Neonatal Edition
JF - Archives of Disease in Childhood: Fetal and Neonatal Edition
M1 - fetalneonatal-2024-328287
ER -