Apneic Oxygenation to Prevent Oxygen Desaturation During Intubation in the NICU

窒息供氧以防止 NICU 插管期间氧饱和度下降

基本信息

批准号：
10373276
负责人：
Elizabeth Foglia
金额：
$ 27.04万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-02-11 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10373276
关键词：
Academy Accident and Emergency department Adherence Adult Adverse event Air American Blood gas Cannulas Cardiopulmonary Resuscitation Caring Child Childhood Complex Control Groups Critical Illness Data Development Emergency Situation Ensure Evaluation Event Funding Future Gestational Age Heart Rate Human Hyperoxia Hypoxia Infant Informed Consent Intensive Care Units Intervention Intervention Studies Intratracheal Intubation Intubation Investigation Knowledge Laryngoscopy Life Lung Masks Methodology Methods Multicenter Studies National Institute of Child Health and Human Development Neonatal Neonatal Intensive Care Units Neurodevelopmental Impairment Nose Operating Rooms Outcome Oxygen Patients Pediatrics Pennsylvania Performance Phase Physiology Population Premedication Procedures Process Protocols documentation Publishing Pulse Oximetry Randomized Randomized Controlled Trials Regimen Registries Research Risk Running Safety Savings Secondary to Site Time Trauma Universities Video Recording adverse outcome arm clinical practice design experience group intervention high risk improved neonatal morbidity novel pediatric patients performance site prevent primary outcome prospective randomized trial respiratory routine provider safety outcomes secondary outcome success supplemental oxygen tool treatment arm ventilation

项目摘要

Tracheal Intubation (TI) is a common, life-saving, high-risk procedure for critically ill infants. Adverse events occur in 18% of tracheal intubations performed in the NICU setting, and almost half (48%) of NICU intubations are complicated by severe oxygen desaturation (≥20% decline in pulse oximetry saturation [SpO2]). Severe desaturation is now recognized as an important contributor to neonatal morbidity and impaired neurodevelopmental outcomes. While modifiable factors have been identified that prevent adverse tracheal intubation associated events, there are limited interventions that consistently prevent severe oxygen desaturation during intubation in NICU patients. Typical practice during intubation in the NICU setting is to remove respiratory support during laryngoscopy and tracheal intubation attempts. Patients are often apneic during this period due to pre-medication administration, a practice that is recommended by the American Academy of Pediatrics. Apneic oxygenation is a strategy in which free flowing oxygen is provided via nasal cannula during laryngoscopy and tracheal intubation. Apneic oxygenation has been demonstrated to prevent or delay oxygen desaturation during intubation in adults and older children. To date, no published studies have systematically assessed the impact of apneic oxygenation during intubation for infants in the NICU setting. In this R21 application we propose a pilot randomized trial of infants ≥28 weeks corrected gestational age who undergo tracheal intubation in the NICU setting to determine if apneic oxygenation, compared with no respiratory support or oxygen during laryngoscopy and tracheal intubation attempt, reduces the magnitude of decline in oxygen saturation during tracheal intubation.

气管插管 (TI) 是危重婴儿常见的救生高风险手术。在 NICU 环境中进行的气管插管中，有 18% 发生不良事件，而近一半 (48%) 的 NICU 插管并发严重氧饱和度下降（氧饱和度下降≥20%）脉搏血氧饱和度 [SpO2]）现在被认为是一个重要的指标。导致新生儿发病和神经发育结果受损的因素，但可以改变。已确定预防不良气管插管相关事件的因素，有持续预防插管期间严重氧饱和度下降的有限干预措施新生儿重症监护室患者。 NICU 插管期间的典型做法是在插管期间取消呼吸支持在此期间，患者经常因喉镜检查和气管插管而呼吸暂停。进行术前给药，这是美国科学院推荐的做法儿科呼吸暂停氧合是一种通过鼻腔提供自由流动氧气的策略。已证明在喉镜检查和气管插管期间插管可导致窒息氧合。预防或延迟成人和年龄较大儿童插管期间的氧饱和度下降。已发表的研究系统地评估了插管期间呼吸暂停氧合的影响对于 NICU 环境中的婴儿，我们提出了一项试点随机试验。在 NICU 接受气管插管的校正胎龄≥28周的婴儿设置以确定呼吸暂停期间是否与没有呼吸支持或氧气的情况相比尝试喉镜检查和气管插管，减少氧饱和度下降的幅度气管插管期间。