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Development of a novel reference nomogram for endotracheal intubation in neonatal emergency transport setting
Author(s) -
Bellini Carlo,
Turolla Giulia,
De Angelis Laura C.,
Calevo Maria Grazia,
Ramenghi Luca A.
Publication year - 2019
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14488
Subject(s) - medicine , endotracheal intubation , nomogram , intubation , emergency medicine , medical emergency , intensive care medicine , anesthesia
Aim Neonatal endotracheal intubation is a challenging procedure during transport. The aim of this study was to evaluate the effectiveness of the emergency intubation guidelines followed by our Neonatal Emergency Transport Service (NETS). Methods Our transport intubation guidelines follows a weight‐based nomogram for nasal intubation, and the tube position is clinically verified after intubation, while the postintubation chest X‐ray is postponed to Neonatal Intensive Care Unit (NICU) admission. Data on postnatal age, weight and tube insertion depth were obtained from the online NETS clinical database, and the postintubation chest X‐ray images were assessed. Results During the study period, 161 newborn infants were nasally intubated during transport, and received a postintubation radiograph at NICU admission. A total of 130 neonates (80.7%) had the endotracheal tube (ETT) correctly positioned between T1 and T2 vertebrae, while 12 (7.5%) was at C7 vertebrae level and 19 (11.8%) at T3. No patients had ETT tip positioned at T4 vertebrae level or below. No adverse events related to intubation were observed. Conclusion Our intubation procedure showed a good reliability and safety in neonatal critical care transport, although chest X‐ray to confirm the tube placement is postponed to NICU arrival. Based on our results, we suggest a revised version of weight‐based nomogram for nasal intubation.