Extremely Preterm Neonate with a Tracheobronchial Foreign Body: A Case Report

Viswanathan, S.; Prado, Yahdira Rodriguez; Chua, Caroline; Calhoun, Darlene A

doi:10.7759/cureus.7659

Cited by 3 publications

(5 citation statements)

References 12 publications

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“…Using a stylet in an ETT may be associated with certain potential risks 19 . The rigidity could provide a disadvantage and may cause airway damage and tracheal injury 20,21 . However, complication rates, including trauma, did not differ among the two groups in our study.…”

Section: Discussionmentioning

confidence: 53%

Randomized controlled trial to evaluate the rate of successful neonatal endotracheal intubation performed with a stylet versus without a stylet

Solanki,

Dogra,

Gupta

et al. 2024

Pediatric Anesthesia

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IntroductionNeonates in intensive care units often require endotracheal intubation and mechanical ventilation. During this intubation procedure, a stylet is frequently used along with an endotracheal tube. Despite the widespread use of a stylet, it is still not known whether its use increases the intubation success rate. This study examined the association between stylet use and the intubation success rate in surgical neonates.MethodologyThis single‐center study was conducted between December 2021 and December 2022 in the Neonatal surgical intensive care unit of a tertiary care center in Northern India. Infants were randomized to have the endotracheal intubation procedure performed using either an endotracheal tube alone or with a stylet. The primary outcome of the study was to assess the successful first‐attempt neonatal endotracheal intubation rate with and without using a stylet. Apart from the rate of successful intubation, the duration of the intubation and complications during the intubation procedures as measured by bradycardia, desaturation episodes, and local trauma were also recorded. Both groups were thus compared on above mentioned outcomes.ResultsThe total number of neonates enrolled were 200, and the overall success rate (81% in the stylet group vs. 73% in the non‐stylet group) was not statistically significant. Intubation time was however less, when stylet was used (16.2 ± 4.3 vs. 17.5 ± 5.0 s, p = .046). When the endotracheal tube size was 3 or less, the success rate was substantially higher in the stylet group (80%) than the non‐stylet group (63%), p = .03. No statistical difference was recorded for bleeding and local trauma, though the esophageal intubation rate was higher when intubation was attempted without the stylet.ConclusionEndotracheal intubation using a stylet did not significantly improve the success rate of the procedure, however, intubation time significantly varied between groups and in different conditions. The rigidity and curvature provided by the stylet may facilitate the process of intubation when smaller caliber endotracheal tubes are used.

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Section: Discussionmentioning

confidence: 53%

Randomized controlled trial to evaluate the rate of successful neonatal endotracheal intubation performed with a stylet versus without a stylet

Solanki,

Dogra,

Gupta

et al. 2024

Pediatric Anesthesia

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“…Multivariate analysis did not show an independent significant association between stylet use and the relevant TIAEs often described in the literature. As the case reports in the literature described, there remain some potential risks involved with stylet use [9-13]. Tracheal perforations are extremely rare events and might require case-control studies to evaluate their relationship with stylets, but the overall low number of airway injuries in this large data set provides some reassurance that these are uncommon outcomes, occurring in <1% of intubations [7].…”

Section: Discussionmentioning

confidence: 99%

“…This practice may potentially increase the risk of the stylet tip positioned beyond the tip of the ETT and injure delicate airway tissue or break off. There are numerous case reports describing airway or ETT obstruction caused by the retained plastic sheath from a stylet, and endoscopic removal of retained stylet components can be especially difficult in premature neonates with small airways [9-13]. Many laryngoscopists bend the ETT and stylet complex which may increase the risk of shearing of the plastic coating resulting in retained stylet components.…”

Section: Discussionmentioning

confidence: 99%

“…The use of a stylet in an ETT presents potential risks. There are numerous case reports of stylet-related adverse outcomes including torn or perforated airways and retained broken stylet pieces [9-13]. In a national survey of neonatal airway providers, 78% had experienced or witnessed an adverse event resulting from stylet use with the most common issue being accidental dislodgement of the ETT during stylet removal necessitating yet another intubation to secure an airway.…”

Section: Introductionmentioning

confidence: 99%

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Associations of Stylet Use during Neonatal Intubation with Intubation Success, Adverse Events, and Severe Desaturation: A Report from NEAR4NEOS

et al. 2021

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Introduction: Intubations are frequently performed procedures in neonatal intensive care units (NICU) and delivery rooms (DR). Unsuccessful first attempts are common as are tracheal intubation-associated events (TIAEs) and severe desaturations. Stylets are often used during intubation, but their association with intubation outcomes is unclear. Objective: To compare intubation success, rate of relevant TIAEs, and severe desaturations in neonates intubated with and without stylets. Methods: Tracheal intubations of neonates in the NICU or DR from 16 centers between October 2014 and December 2018, performed by neonatology or pediatric providers, were collected from the NEAR4NEOs international registry. Primary oral intubations with a laryngoscope were included in the analysis. First-attempt success, the occurrence of relevant TIAEs, and severe oxygen desaturation (≥20% saturation drop from baseline) were compared between intubations performed with versus without a stylet. Logistic regression with generalized estimate equations was used to control for covariates and clustering by sites. Results: Out of 5,292 primary oral intubations, 3,877 (73%) utilized stylets. Stylet use varied considerably across the centers with a range between 0.5 and 100%. Stylet use was not associated with first-attempt intubation success, esophageal intubation, mainstem intubation, or severe desaturations after controlling for confounders. Patient size was associated with these outcomes and much more predictive of success. Conclusions: Stylet use during neonatal intubation was not associated with higher first-attempt intubation success, fewer relevant TIAEs, or less severe desaturations. These data suggest that stylets can be used based on individual preference, but stylet use may not be associated with better intubation outcomes.

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“…8 Several case reports have been published on the hazards of stylet use in the neonatal population. [9][10][11][12][13][14] These primarily detail the risk of broken stylet components leading to foreign body aspiration and ETT or tracheobronchial obstruction. Additional stylet-associated complications include airway injury, bleeding, tracheal tears, and tracheal perforation.…”

Section: Discussionmentioning

confidence: 99%

Endotracheal Intubation in a Difficult Neonatal Airway: A Case Report of a 16-Gauge Intravenous Catheter for Use as an Intubating Stylet

2021

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Neonatal airways present unique management challenges that can be compounded by limitations of an underresourced facility. While little clinical data exist on the safety and efficacy of stylet use, they are commonly utilized to facilitate endotracheal intubation in neonates and anticipated difficult airways. As pediatric airway equipment is often understocked in hospitals, innovative thinking can provide creative solutions to these shortages. We present the use of a 16-gauge intravenous catheter as an intubating stylet for a 2.0-millimeter endotracheal tube in the management of a difficult airway in the neonatal intensive care unit. (A&A Practice. 2021;15:e01467.

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Extremely Preterm Neonate with a Tracheobronchial Foreign Body: A Case Report

Cited by 3 publications

References 12 publications

Randomized controlled trial to evaluate the rate of successful neonatal endotracheal intubation performed with a stylet versus without a stylet

Randomized controlled trial to evaluate the rate of successful neonatal endotracheal intubation performed with a stylet versus without a stylet

Associations of Stylet Use during Neonatal Intubation with Intubation Success, Adverse Events, and Severe Desaturation: A Report from NEAR4NEOS

Endotracheal Intubation in a Difficult Neonatal Airway: A Case Report of a 16-Gauge Intravenous Catheter for Use as an Intubating Stylet

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