Premedication practices for tracheal intubation in neonates transported by French medical transport teams: a prospective observational study

Ricardo Carbajal, Noella Lode, Azzedine Ayachi, Ourida Chouakri, Véronique Henry-Larzul, Katia Kessous, Audrey Normand, Emilie Courtois, Jessica Rousseau, Patricia Cimerman, Jean-Louis Chabernaud, Ricardo Carbajal, Noella Lode, Azzedine Ayachi, Ourida Chouakri, Véronique Henry-Larzul, Katia Kessous, Audrey Normand, Emilie Courtois, Jessica Rousseau, Patricia Cimerman, Jean-Louis Chabernaud

Abstract

Objectives: Premedication practices for neonatal tracheal intubations have not yet been described for neonatal transport teams. Our objective is to describe the use of sedation/analgesia (SA) for tracheal intubations and to assess its tolerance in neonates transported by medical transport teams in France.

Setting: This prospective observational study was part of the EPIPPAIN 2 project and collected around-the-clock data on SA practices in neonates intubated by all five paediatric medical transport teams of the Paris region during a 2-month period. Intubations were classified as emergent, semiemergent and non-emergent. Sedation level and conditions of intubation were assessed with the Tonus, Reactivity, Awareness and Conditions of intubation to Help in Endotracheal intubation Assessment (TRACHEA score). The scores range from 0 to 10 representing an increasing ladder from adequate to inadequate sedation, and from excellent to very poor conditions of intubation.

Participants: 40 neonates intubated in 28 different centres.

Results: The mean (SD) age was 34.9 (3.9) weeks, and 62.5% were intubated in the delivery room. 30/40 (75%) of intubations were performed with the use of SA. In 18/30 (60.0%) intubations performed with SA, the drug regimen was the association of sufentanil and midazolam. Atropine was given in 19/40 intubations. From the 16, 21 and 3 intubations classified as emergent, semiemergent and non-emergent, respectively, 8 (50%), 19 (90.5%) and 3 (100%) were performed with SA premedication. 79.3% of intubations performed with SA had TRACHEA scores of 3 or less. 22/40 (55%) infants had at least one of the following adverse events: muscle rigidity, bradycardia below 100/min, desaturation below 80% and nose or pharynx-larynx bleeding. 7/24 (29.2%) of those who had only one attempt presented at least one of these adverse events compared with 15/16 (93.8%) of those who needed two or more attempts (p<0.001).

Conclusion: SA premedication is largely feasible for tracheal intubations performed in neonates transported by medical transport teams including intubations judged as emergent or semiemergent.

Trial registration number: NCT01346813; Results.

Keywords: epidemiology; intubation; neonatal intensive & critical care; neonatology; pain management.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Correlations between TRACHEA scores and operator and assistant pain/discomfort assessments (0–10 scale) during the endotracheal intubation of 39 neonates (data missing for one neonate). The correlation coefficient (Rho Spearman) between the TRACHEA score and the operator (A) and assistant assessment (B) of pain or discomfort were 0.755 (pTonus, Reactivity, Awareness, and Conditions of intubation to Help in Endotracheal intubation Assessment.

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