Nasal High-Flow Therapy during Neonatal Endotracheal Intubation

Hodgson, Kate; Owen, Louise; Kamlin, C. Omar F.; Roberts, Calum T.; Newman, Sophie E.; Francis, Kate; Donath, Susan; Davis, Peter G; Manley, Brett J.

doi:10.1056/nejmoa2116735

Cited by 61 publications

(49 citation statements)

References 34 publications

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“…Our study ndings were consistent with recent studies in neonatal ICU and pediatric operating rooms. A randomized control trial by Hodgson et al demonstrated that nasal high-ow therapy during TI procedures improved the likelihood of successful intubation on the rst attempt without physiological instability in the premature infant (median 27.9 weeks) in two Australian neonatal ICUs [19]. The success rate in the intervention group was 50% wheras the control group was 31.5%, with adjusted risk difference 17.6% (95% CI: 6-29.2).…”

Section: Discussionmentioning

confidence: 99%

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Utility of Apneic Oxygenation with Intubation to Reduce Severe Desaturation and Adverse Tracheal Intubation Associated Events in Critically Ill Children

Napolitano

Polikoff

Edwards

et al. 2022

Preprint

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Background Determine if apneic oxygenation (AO) delivered via nasal cannula during the apneic phase of tracheal intubation (TI), reduces adverse TI-associated events (TIAEs) in children. Methods AO was implemented across 14 pediatric intensive care units (ICUs) as a quality improvement intervention during 2016–2020. Implementation consisted of an intubation safety checklist, leadership endorsement, local champion, and data feedback to frontline clinicians. Standardized oxygen flow via nasal cannula for AO were as follows: 5 liters/minute for infants (< 1 year), 10 liters/minute for young children (1–7 years), and 15 liters/minute for older children (≥ 8 years). Outcomes were the occurrence of adverse TIAEs (primary) and hypoxemia (SpO2 < 80%, secondary). Results Of 6,549 TIs during the study period, 2,554 (39.0%) occurred during the pre-implementation phase and 3,995 (61.0%) during post-implementation phase. AO utilization increased from 23–68%, p < 0.001. AO was utilized less often when intubating infants, those with a primary cardiac diagnosis or difficult airway features, and patient intubated due to respiratory or neurological failure or shock. Conversely, AO was used more often in TIs done for procedures and those assisted by video laryngoscopy. AO utilization was associated with a lower incidence of adverse TIAEs (AO 10.5% vs without AO 13.5%, p < 0.001), aOR 0.75 (95% CI 0.58–0.98, p = 0.03) after adjusting for site clustering (primary analysis). However, after further adjusting for patient and provider characteristics (secondary analysis), AO utilization was not independently associated with the occurrence of adverse TIAEs: aOR 0.90, 95% CI 0.72–1.12, p = 0.33. The occurrence of hypoxemia was not different: AO 14.2% vs without AO 15.2%, p = 0.43. Conclusion AO utilization was associated with a lower occurrence of adverse TIAEs in patients undergoing TI in the pediatric ICU.

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Section: Discussionmentioning

confidence: 99%

“…Apneic oxygenation (AO), the application of oxygen to the nasopharynx during the apneic phase of TI procedures, has been shown to reduce hypoxemia and extend the duration of safe intubation attempts in adult [13][14][15], pediatric [16][17][18], and neonatal studies [19].…”

Section: Introductionmentioning

confidence: 99%

Utility of Apneic Oxygenation with Intubation to Reduce Severe Desaturation and Adverse Tracheal Intubation Associated Events in Critically Ill Children

Napolitano

Polikoff

Edwards

et al. 2022

Preprint

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“…Recently, the SHINE study compared HVNI to standard care for preoxygenation of neonates undergoing endotracheal intubation. Here, 50% of first-attempt intubations were successful with HVNI compared to 31.5% with standard of care ( 87 ). Desaturation in HVNI-treated neonates occurred at a lower percentage with a longer mean time to desaturation (44.3 and 35.5 s, respectively); NNT =6 ( 87 ).…”

Section: Use Of High Flow Nasal Oxygen In Proceduresmentioning

confidence: 98%

“…Here, 50% of first-attempt intubations were successful with HVNI compared to 31.5% with standard of care ( 87 ). Desaturation in HVNI-treated neonates occurred at a lower percentage with a longer mean time to desaturation (44.3 and 35.5 s, respectively); NNT =6 ( 87 ). These results suggest HVNI improves intubation success with lowered risk of adverse events and these data suggest that neonates, infants, and children likely benefit from preoxygenation with HFNO before intubation.…”

Section: Use Of High Flow Nasal Oxygen In Proceduresmentioning

confidence: 98%

Recent advances in the use of high flow nasal oxygen therapies

Wyatt¹,

Goel

Whittle

2022

Front. Med.

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High flow nasal oxygen is a relatively new option for treating patients with respiratory failure, which decreases work of breathing, improves tidal volume, and modestly increases positive end expiratory pressure. Despite well-described physiologic benefits, the clinical impact of high flow nasal oxygen is still under investigation. In this article, we review the most recent findings on the clinical efficacy of high flow nasal oxygen in Type I, II, III, and IV respiratory failure within adult and pediatric patients. Additionally, we discuss studies across clinical settings, including emergency departments, intensive care units, outpatient, and procedural settings.

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“…Nasal high‐flow therapy is often used for elective intubation of children and adults for general anaesthesia. A randomised, controlled trial at two Australian tertiary neonatal intensive care units compared nasal high‐flow therapy with standard care in 202 neonates undergoing oral endotracheal intubation on 251 occasions 1 . The primary outcome was successful intubation on the first attempt without physiological instability (defined as an absolute decrease in the peripheral oxygen saturation of >20% from pre‐intubation baseline level or bradycardia <100 beats per minute).…”

mentioning

confidence: 99%