Cerebral Oxygenation During Neonatal Intubation-Ancillary Study of the Prettineo-Study

Abstract

Purpose: This study aimed to describe cerebral Near InfraRed Spectroscopy (NIRS) profiles during neonatal intubation using two different premedication regimens. Methods: Neonates requiring non-emergency intubation were enrolled in an ancillary study, conducted in two French Neonatal Intensive Care Units participating in a larger on-going multicenter, double blind, randomized, controlled trial. Patients were randomly assigned to the "atropine-propofol" (Prop) group or the "atropine-atracurium-sufentanil" (SufTrac) group. Regional cerebral oxygen saturation (rScO2), pulse oxymetry (SpO2), mean arterial blood pressure (MABP), and transcutaneous partial pressure of carbon dioxide (TcPCO2) were collected at 9 predefined time points from 1 min before to 60 min after the first drug injection. The two primary outcomes were a decrease in rScO2 value >20% from baseline and a decrease in fractional cerebral tissue oxygen extraction (FTOE) value >10% from baseline, at any time point. Secondary outcomes included physiological parameters changes over time and correlations between mean arterial blood pressure, and FTOE at different time points. Descriptive results were obtained and exploratory statistical analyses were performed for 24 included patients. Results: rScO2 decreased in 5/11 (46%) infants from the Prop group and 10/13 (77%) from the SufTrac group (p = 0.11); FTOE decreased in 10/11 (91%) infants from the Prop group, and 12/13 (92%) from the SufTrac group (p = 0.90). rScO2 values decreased over time in both groups, whereas FTOE's pattern appeared more stable. SpO2 and transcutaneous TcPCO2 seemed more preserved in the Prop group while MABP seemed more preserved in the SufTrac group. No important correlation was observed between MABP and FTOE (r = 0.08 to 0.12 across the time points). Conclusion: Our results suggest a frequent decrease in cerebral oxygenation without obvious impairment in cerebral autoregulation during neonatal intubation with premedication. This study confirms the feasibility and the informative value of cerebral NIRS monitoring in this setting. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02700893.

Keywords: cerebral oxygenation; hypotension; near infrared spectroscopy; neonatal intubation; premedication; propofol.

Figures

Figure 1

Population flow chart.

Figure 2

Physiological parameters and cerebral oxygenation changes overtime. These graphs illustrate the mean values (points) and 95% CI (error bars) on the Y axis for rScO2(A), FTOE (B), SpO2(C), MABP (D), TcPCO2(E), and HR (F) over time. The x-axis indicates the time before and after first drug injection (denoted as “0”) in min. Graphs are presented in red for the atropine-propofol group and in blue for the atropine-atracurium-sufentanil group. CI, confidence interval; rScO2, regional cerebral oxygen saturation; FTOE, fractional cerebral tissue oxygen extraction; SpO2, oxygen saturation; MABP, mean arterial blood pressure; TcPCO2, transcutaneous partial carbon dioxide pressure; HR, heart rate.

Figure 3

Correlation between FTOE and MABP at predefined time points. These graphs illustrate the correlation between FTOE (Y axis) and MABP (X axis) 1 min before (A), and 6 min (B), and 15 min (C) after the first drug injection. Each point represents a patient, the solid line represents the regression line and the colored area represents the 95% CI interval within each group (atropine-propofol in red, atropine-atracurium-sufentanil in blue). Pearson correlation coefficients calculated for the whole population (global) and for each group are included below the graph for each time point. FTOE, fractional cerebral tissue oxygen extraction; MABP, mean arterial blood pressure.