Neonatal Airway Management

Park, Raymond S.; Peyton, James; Kovatsis, Pete G.

doi:10.1016/j.clp.2019.08.008

Cited by 40 publications

(16 citation statements)

References 49 publications

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“…In 2008, Jonathan Wyllie recommended that in an emergency, oral intubation should be the first choice as it decreases intubation time, is more likely to be successful on first attempt and is less traumatic (24). However, the choice between primary nasal and oral intubation remains mainly driven by institutional preference and HCW experience (25). Nasally placed tubes have been perceived to be more secure and comfortable for neonatal patients (25).…”

Section: Nasal Vs Oral Intubationmentioning

confidence: 99%

“…However, the choice between primary nasal and oral intubation remains mainly driven by institutional preference and HCW experience (25). Nasally placed tubes have been perceived to be more secure and comfortable for neonatal patients (25). However, a Cochrane review found no clear advantage of either nasal or oral intubation of newborn infants with respect to tissue trauma, infection, tube malposition/blockage/dislodgement, accidental extubation or re-intubation (26).…”

Section: Nasal Vs Oral Intubationmentioning

confidence: 99%

“…In expected and unexpected difficult intubation in children, patients <10 kg are more prone to complications than larger patients (65). This is because of rapid desaturation due to a lower functional residual capacity and higher oxygen consumption, as well as lower success rates of advanced airway rescue techniques (25,66). Therefore, any airway management procedure should anticipate the possible failure of and plan one step ahead.…”

Section: Policies and Proceduresmentioning

confidence: 99%

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Management of the Unexpected Difficult Airway in Neonatal Resuscitation

et al. 2021

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A “difficult airway situation” arises whenever face mask ventilation, laryngoscopy, endotracheal intubation, or use of supraglottic device fail to secure ventilation. As bradycardia and cardiac arrest in the neonate are usually of respiratory origin, neonatal airway management remains a critical factor. Despite this, a well-defined in-house approach to the neonatal difficult airway is often lacking. While a recent guideline from the British Pediatric Society exists, and the Scottish NHS and Advanced Resuscitation of the Newborn Infant (ARNI) airway management algorithm was recently revised, there is no Norwegian national guideline for managing the unanticipated difficult airway in the delivery room (DR) and neonatal intensive care unit (NICU). Experience from anesthesiology is that a “difficult airway algorithm,” advance planning and routine practicing, prepares the resuscitation team to respond adequately to the technical and non-technical stress of a difficult airway situation. We learned from observing current approaches to advanced airway management in DR resuscitations in a university hospital and make recommendations on how the neonatal difficult airway may be managed through technical and non-technical approaches. Our recommendations mainly pertain to DR resuscitations but may be transferred to the NICU environment.

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Section: Nasal Vs Oral Intubationmentioning

confidence: 99%

Section: Nasal Vs Oral Intubationmentioning

confidence: 99%

Section: Policies and Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

Management of the Unexpected Difficult Airway in Neonatal Resuscitation

et al. 2021

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“…Unique anatomy can complicate neonate and infant airway management [ 1 , 2 ], and unexpected airway emergencies arise frequently in neonatal intensive care units. Further, management of neonates delivered at quaternary children’s hospitals with complex airway issues can demand “on call” multidisciplinary teams [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Airway emergency management in a pediatric hospital before and during the COVID-19 pandemic

Thom

Deshmukh

Soorikian

et al. 2020

International Journal of Pediatric Otorhinolaryngology

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Objective Children’s hospitals frequently care for infants with various life-threatening airway anomalies. Management of these infants can be challenging given unique airway anatomy and potential malformations. Airway emergency management must be immediate and precise, often demanding specialized equipment and/or expertise. We developed a Neonatal-Infant Emergency Airway Program to improve medical responses, communication, equipment usage and outcomes for all infants requiring emergent airway interventions in our neonatal and infant intensive care unit (NICU). Patients and Methods All patients admitted to our quaternary NICU from 2008-2019 were included in this study. Our program consisted of a multidisciplinary airway response team, pager system, and emergency equipment cart. Respiratory therapists present at each emergency event recorded specialist response times, equipment utilization, and outcomes. A multidisciplinary oversite committee reviewed each incident. Results Since 2008, there were 159 airway emergency events in our NICU (∼12 per year). Mean specialist response times decreased from 5.9±4.9 min (2008-2012, mean±SD) to 4.3±2.2 min (2016-2019, p=0.12), and the number of incidents with response times >5 min decreased from 28.8±17.8% (2008-2012) to 9.3±11.4% (2016-2019, p=0.04 by linear regression). As our program became more standardized, we noted better equipment availability and subspecialist communication. Few emergency situations (n=9, 6%) required operating room management. There were 3 patient deaths (2%). Conclusions Our airway safety program, including readily available specialists and equipment, facilitated effective resolution of airway emergencies in our NICU and multidisciplinary involvement enabled rapid and effective changes in response to COVID-19 regulations. A similar program could be implemented in other centers.

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“…Unique anatomy can complicate neonate and infant airway management [1,2], and unexpected airway emergencies arise frequently in neonatal intensive care units. Further, management of neonates delivered at quaternary children’s hospitals with complex airway issues can demand “on call” multidisciplinary teams [3].…”

Section: Introductionmentioning

confidence: 99%

Airway emergency management in a pediatric hospital before and during the COVID-19 pandemic

Thom

Deshmukh

Soorikian

et al. 2020

Preprint

View full text Add to dashboard Cite

Objective Children's hospitals frequently care for infants with various life-threatening airway anomalies. Management of these infants can be challenging given unique airway anatomy and potential malformations. Airway emergency management must be immediate and precise, often demanding specialized equipment and/or expertise. We developed a Neonatal-Infant Airway Safety Program to improve medical responses, communication, equipment usage and outcomes for infants requiring emergent airway interventions. Patients and Methods All patients admitted to our quaternary neonatal and infant intensive care unit (NICU) from 2008-2019 were included in this study. Our program consisted of a multidisciplinary airway response team, pager system, and emergency equipment cart. Respiratory therapists present at each emergency event recorded specialist response times, equipment utilization, and outcomes. A multidisciplinary oversite committee reviewed each incident. Results Since 2008, there were 159 airway emergency events in our NICU (~12 per year). Mean specialist response times decreased from 5.9±4.9 min (2008-2012, mean±SD) to 4.3±2.2 min (2016-2019, p=0.12), and the number of incidents with response times >5 min decreased from 28.8±17.8% (2008-2012) to 9.3±11.4% (2016-2019, p=0.04 by linear regression). As our program became more standardized, we noted better equipment availability and subspecialist communication. Few emergency situations (n=9, 6%) required operating room management. There were 3 patient deaths (2%). Conclusions Our airway safety program, including readily available specialists and equipment, facilitated effective resolution of airway emergencies in our NICU and multidisciplinary involvement enabled rapid and effective changes in response to COVID-19 regulations. A similar program could be implemented in other centers.

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Neonatal Airway Management

Cited by 40 publications

References 49 publications

Management of the Unexpected Difficult Airway in Neonatal Resuscitation

Management of the Unexpected Difficult Airway in Neonatal Resuscitation

Airway emergency management in a pediatric hospital before and during the COVID-19 pandemic

Airway emergency management in a pediatric hospital before and during the COVID-19 pandemic

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