Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study.
Age Factors
Anesthesia
/ adverse effects
Europe
/ epidemiology
Female
Humans
Hypoxia
/ diagnosis
Incidence
Infant
Infant, Newborn
Intubation, Intratracheal
/ adverse effects
Laryngoscopy
/ adverse effects
Male
Medical Audit
Prospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
airways
anaesthesia
difficult intubation
infants
morbidity
mortality
neonates
paediatric
Journal
British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
20
01
2021
revised:
19
02
2021
accepted:
22
02
2021
pubmed:
5
4
2021
medline:
2
6
2021
entrez:
4
4
2021
Statut:
ppublish
Résumé
Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1-6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. NCT02350348.
Sections du résumé
BACKGROUND
BACKGROUND
Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences.
METHODS
METHODS
We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes.
RESULTS
RESULTS
Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1-6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO
CONCLUSIONS
CONCLUSIONS
The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event.
CLINICAL TRIAL REGISTRATION
BACKGROUND
NCT02350348.
Identifiants
pubmed: 33812665
pii: S0007-0912(21)00116-1
doi: 10.1016/j.bja.2021.02.021
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT02350348']
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1173-1181Investigateurs
Christian Breschan
(C)
Rudolf Likar
(R)
Manuela Platzer
(M)
Isole Edelman
(I)
Johanes Eger
(J)
Stefan Heschl
(S)
Brigitte Messerer
(B)
Maria Vittinghof
(M)
Ruth Kroess
(R)
Martina Stichlberger
(M)
David Kahn
(D)
Thierry Pirotte
(T)
Caroline Pregardien
(C)
Francis Veyckemans
(F)
France Stevens
(F)
Johan Berghmans
(J)
Annemie Bauters
(A)
Luc De Baerdemaeker
(L)
Stefan De Hert
(S)
Koen Lapage
(K)
Aliaksandra Parashchanka
(A)
Jurgen Van Limmen
(J)
Piet Wyffels
(P)
Julie Lauweryns
(J)
Nadia Najafi
(N)
Joris Vundelinckx
(J)
Diana Butković
(D)
Ivana Kerovec Sorić
(I)
Sandra Kralik
(S)
Ana Markić
(A)
Josip Azman
(J)
Josko Markic
(J)
Daniela Pupacic
(D)
Michal Frelich
(M)
Petr Reimer
(P)
René Urbanec
(R)
Petra Cajková
(P)
Vladimír Mixa
(V)
Yvona Sedláčková
(Y)
Lenka Knoppová
(L)
Alena Zlámalová Neé Květoňová
(A)
Martin Vavřina
(M)
Jiří Žurek
(J)
Tom Hansen
(T)
Arash Afshari
(A)
Anders Bastholm Bille
(AB)
Marguerite Ellekvist
(M)
Mari-Liis Ilmoja
(ML)
Reet Moor
(R)
Reet Kikas
(R)
Merle Väli
(M)
Kariantti Kallio
(K)
Elisa Reponen
(E)
Pertti Suominen
(P)
Sami Suvanto
(S)
Raisa Vähätalo
(R)
Hannu Kokki
(H)
Merja Kokki
(M)
Jarkko Harju
(J)
Miia Kokkonen
(M)
Jenni Vieri
(J)
Tuula Manner
(T)
Catherine Amory
(C)
Hugues Ludot
(H)
Dina Bert
(D)
Juliette Godart
(J)
Anne Laffargue
(A)
Hervé Dupont
(H)
Benjamin Urbina
(B)
Catherine Baujard
(C)
Philippe Roulleau
(P)
Giuseppe Staiti
(G)
Maryline Bordes
(M)
Karine Nouette Gaulain
(K)
Yann Hamonic
(Y)
François Semjen
(F)
Olivier Jacqmarcq
(O)
Caroline Lejus-Bourdeau
(C)
Cécile Magne
(C)
Léa Petry
(L)
Lilica Ros
(L)
Aurélien Zang
(A)
Mehdi Bennis
(M)
Bernard Coustets
(B)
Rose Fesseau
(R)
Isabelle Constant
(I)
Eliane Khalil
(E)
Nada Sabourdin
(N)
Noemie Audren
(N)
Thomas Descarpentries
(T)
Fanny Fabre
(F)
Aurélien Legrand
(A)
Emilie Druot
(E)
Gilles Orliaguet
(G)
Lucie Sabau
(L)
Lynn Uhrig
(L)
François de la Brière
(F)
Karin Jonckheer
(K)
Jean-Paul Mission
(JP)
Lucia Scordo
(L)
Caroline Couchepin
(C)
Christophe Dadure
(C)
Pablo De la Arena
(P)
Laurent Hertz
(L)
Philippe Pirat
(P)
Chrystelle Sola
(C)
Myriam Bellon
(M)
Souhayl Dahmani
(S)
Florence Julien-Marsollier
(F)
Daphne Michelet
(D)
Veronique Depret-Donatien
(V)
Anne Lesage
(A)
Jost Kaufmann
(J)
Michael Laschat
(M)
Frank Wappler
(F)
Karin Becke
(K)
Lena Brunner
(L)
Karin Oppenrieder
(K)
Gregor Badelt
(G)
Karin Hochmuth
(K)
Bernhard Koller
(B)
Anita Reil
(A)
Sebastian Richter
(S)
Thomas Fischer
(T)
Anja Diers
(A)
Clemens Schorer
(C)
Andreas Weyland
(A)
Ruth Cohausz
(R)
Franz-Josef Kretz
(FJ)
Michaela Löffler
(M)
Markus Wilbs
(M)
Claudia Hoehne
(C)
Johanna Ulrici
(J)
Christiane Goeters
(C)
Armin Flinspach
(A)
Matthias Klages
(M)
Simone Lindau
(S)
Leila Messroghli
(L)
Kai Zacharowski
(K)
Christoph Eisner
(C)
Thomas Mueller
(T)
Daniel Richter
(D)
Melanie Schäfer
(M)
Markus Weigand
(M)
Sebastian Weiterer
(S)
Miriam Ochsenreiter
(M)
Michael Schöler
(M)
Tom Terboven
(T)
Isabel Eggemann
(I)
Sascha Haussmann
(S)
Nicolas Leister
(N)
Christoph Menzel
(C)
Uwe Trieschmann
(U)
Sirin Yücetepe
(S)
Susanna Keilig
(S)
Peter Kranke
(P)
Yvonne Jelting
(Y)
Torsten Baehner
(T)
Richard Ellerkmann
(R)
Shahab Ghamari
(S)
Claudia Neumann
(C)
Martin Söhle
(M)
Pelagia Chloropoulou
(P)
Vagia Ntritsou
(V)
Pinelopi Papagiannopoulou
(P)
Eleana Garini
(E)
Afroditi Karafotia
(A)
Panagoula Mammi
(P)
Evangelia Bali
(E)
Despoina Iordanidou
(D)
Anna Malisiova
(A)
Artemis Polyzoi
(A)
Adelais Tsiotou
(A)
Erzsebet Sapi
(E)
Edgar Székely
(E)
Nandor Kosik
(N)
Veronika Maráczi
(V)
Janos Schnur
(J)
Judit Csillag
(J)
János Gál
(J)
Gergely Göbl
(G)
Balázs Hauser
(B)
András Petróczy
(A)
Gyula Tövisházi
(G)
Stuart Blain
(S)
Sarah Gallagher
(S)
Sinead Harte
(S)
Mandy Jackson
(M)
Emma Meehan
(E)
Zeenat Nawoor
(Z)
Brendan O'Hare
(B)
Mark Ross
(M)
Daniela Lerro
(D)
Marinella Astuto
(M)
Chiara Grasso
(C)
Rita Scalisi
(R)
Giulia Frasacco
(G)
Elena Lenares
(E)
Roberto Leone
(R)
Maurizia Grazzini
(M)
Carmelo Minardi
(C)
Nicola Zadra
(N)
Gilda Cinnella
(G)
Antonella Cotoia
(A)
Dario Galante
(D)
Brita De Lorenzo
(B)
Beate Kuppers
(B)
Giulia Bottazzi
(G)
Fabio Caramelli
(F)
Maria Cristina Mondardini
(MC)
Emanuele Rossetti
(E)
Sergio Picardo
(S)
Alessandro Vittori
(A)
Anna Camporesi
(A)
Andrea Wolfler
(A)
Edoardo Calderini
(E)
Laura Brigitta Colantonio
(LB)
Simona Anna Finamore
(SA)
Giuliana Anna Porro
(GA)
Rachele Bonfiglio
(R)
Nicola Disma
(N)
Svetlana Kotzeva
(S)
Leila Mameli
(L)
Girolamo Mattioli
(G)
Camilla Micalizzi
(C)
Alessia Montaguti
(A)
Angela Pistorio
(A)
Clelia Zanaboni
(C)
Anna Guddo
(A)
Gerald Rogan Neba
(GR)
Moreno Favarato
(M)
Bruno Guido Locatelli
(BG)
Micol Maffioletti
(M)
Valter Sonzogni
(V)
Rossella Garra
(R)
Maria Sammartino
(M)
Fabio Sbaraglia
(F)
Andrea Cortegiani
(A)
Alessandra Moscarelli
(A)
Elena Attanasi
(E)
Simonetta Tesoro
(S)
Cristina Agapiti
(C)
Francesca Pinzoni
(F)
Cesare Vezzoli
(C)
Federico Bilotta
(F)
Arta Barzdina
(A)
Zane Straume
(Z)
Anda Zundane
(A)
Laura Lukosiene
(L)
Irena Maraulaite
(I)
Ilona Razlevice
(I)
Bernd Schmitz
(B)
Stephanie Mifsud
(S)
Carolin Aehling
(C)
Celia Allison
(C)
Rients De Boer
(R)
Dina Emal
(D)
Markus Stevens
(M)
Marielle Buitenhuis
(M)
Jurgen de Graaff
(J)
Inge De Liefde
(I)
Andreas Machotta
(A)
Gail Scoones
(G)
Lonneke Staals
(L)
Jeremy Tomas
(J)
Anouk Van der Knijff-van Dortmont
(A)
Marianne Veldhuizen
(M)
David Alders
(D)
Wolfgang Buhre
(W)
Eva Schafrat
(E)
Jan Schreiber
(J)
Petronella Mari Vermeulen
(PM)
Mark Hendriks
(M)
Sandra Lako
(S)
Marieke Voet-Lindner
(M)
Barbe Pieters
(B)
Gert-Jan Scheffer
(GJ)
Luc Tielens
(L)
Anthony R Absalom
(AR)
Margot Bergsma
(M)
Joke De Ruiter
(J)
Sascha Meier
(S)
Martin Volkers
(M)
Tjerk Zweers
(T)
Anne M Beukers
(AM)
Christa Boer
(C)
Jurgen Dertinger
(J)
Sandra Numan
(S)
Bas Van Zaane
(B)
Wenche B Boerke
(WB)
Nil Ekiz
(N)
Kristoffer Stensrud
(K)
Inger Marie Drage
(IM)
Erik Ramon Isern
(ER)
Alicja Bartkowska-Sniatkowska
(A)
Malgorzata Grzeskowiak
(M)
Magdalena Juzwa-Sobieraj
(M)
Jowita Rosada-Kurasińska
(J)
Artur Baranowski
(A)
Karina Jakubowska
(K)
Dorota Lewandowska
(D)
Magdalena Mierzewska-Schmidt
(M)
Piotr Sawicki
(P)
Magdalena Urban-Lechowicz
(M)
Pomianek Przemyslaw
(P)
Marzena Zielinska
(M)
Teresa Leal
(T)
Maria Soares
(M)
Pedro Pina
(P)
Sílvia Pinho
(S)
Maria Domingas Patuleia
(MD)
Catarina Cruz Esteves
(CC)
Helena Salgado
(H)
Maria João Santos
(MJ)
Rodica Badeti
(R)
Iulia Cindea
(I)
Loredana Oana
(L)
Adriana Gurita
(A)
Luminita Ilie
(L)
Gabriel Mocioiu
(G)
Radu Tabacaru
(R)
Irina Trante
(I)
Valentin Munteanu
(V)
Mihai Morariu
(M)
Emese Nyíri
(E)
Ivana Budic
(I)
Vesna Marjanovic
(V)
Biljana Drašković
(B)
Marina Pandurov
(M)
Jordanka Ilic
(J)
Ana Mandras
(A)
Zdenka Rados
(Z)
Nikola Stankovic
(N)
Maja Suica
(M)
Sladjana Vasiljevic
(S)
Mirjana Knezevic
(M)
Irina Milojevic
(I)
Ivana Petrov
(I)
Selena Puric Racic
(S)
Dusica Simic
(D)
Irena Simic
(I)
Marija Stevic
(M)
Irena Vulicevic
(I)
Barbora Cabanová
(B)
Miloslav Hanula
(M)
Jelena Berger
(J)
Darja Janjatovic
(D)
Špela Pirtovšek Štupnik
(Š)
Dolores Méndez
(D)
Gema Pino
(G)
Paloma Rubio
(P)
Alberto Izquierdo
(A)
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(S)
Cristina González Serrano
(C)
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(J)
Ana Peleteiro
(A)
Pilar Del Rey de Diego
(P)
Ernesto Martínez García
(E)
Carolina Tormo de Las Heras
(C)
Pablo Troncoso Montero
(P)
Celia Arbona
(C)
David Artés
(D)
Alicia Chamizo
(A)
Silvia Serrano
(S)
Montserrat Suarez Comas
(M)
Francisco Escribá
(F)
Cristina Auli
(C)
Osvaldo Pérez Pardo
(O)
Natalia Sierra Biddle
(N)
Ceferina Suárez Castaño
(C)
María Isabel Villalobos Rico
(MI)
Susana Manrique Muñoz
(S)
Irene García Martínez
(I)
Nuria Montferrer Estruch
(N)
Elena Vilardell Ortíz
(E)
Rodrigo Poves-Álvarez
(R)
Ivan Kohn
(I)
Ulf Lindestam
(U)
Jarl Reinhard
(J)
Albert Castellheim
(A)
Kerstin Sandström
(K)
Sporre Bengt
(S)
Rainer Dörenberg
(R)
Peter Frykholm
(P)
Maria Garcia
(M)
Ann Kvarnström
(A)
Emma Pontén
(E)
Thomas Bruelisauer
(T)
Gabor Erdoes
(G)
Heiko Kaiser
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Mathias Marchon
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Stefan Seiler
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Mirko Dolci
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Carine Marcucci
(C)
Walid Habre
(W)
Isabelle Pichon
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(L)
Mattias Casutt
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Martin Hölzle
(M)
Thomas Hurni
(T)
Martin Jöhr
(M)
Anna-Ursina Malär
(AU)
Jacqueline Mauch
(J)
Thomas Erb
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Karin Oeinck
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Mine Akin
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Gulsen Keskin
(G)
Yesim Senayli
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Guner Kaya
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Pinar Kendigelen
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Ayse Çiğdem Tutuncu
(AÇ)
Zehra Hatipoğlu
(Z)
Dilek Özcengiz
(D)
Hale Aksu Erdost
(HA)
Elvan Öçmen
(E)
Çimen Olguner
(Ç)
Hilmi Ayanoglu
(H)
Pelin Corman Dincer
(PC)
Tumay Umuroglu
(T)
Mustafa Azizoglu
(M)
Handan Birbiçer
(H)
Nurcan Doruk
(N)
Aslı Sagun
(A)
Sibel Baris
(S)
Dmytro Dmytriiev
(D)
Sridevi Kuchi
(S)
Nuria Masip
(N)
Peter Brooks
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Alison Hare
(A)
Nargis Ahmad
(N)
Michelle Casey
(M)
Sam De Silva
(S)
Nadine Dobby
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Prakash Krishnan
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L Amaki Sogbodjor
(LA)
Ellie Walker
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Suellen Walker
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Stephanie King
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Katy Nicholson
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Michelle Quinney
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Andrew Blevin
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Mariangela Giombini
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Chulananda Goonasekera
(C)
Sadia Adil
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Stephanie Bew
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Carol Bodlani
(C)
Dan Gilpin
(D)
Stephanie Jinks
(S)
Nalini Malarkkan
(N)
Alice Miskovic
(A)
Rebecca Pad
(R)
Juliet Wolfe Barry
(J)
Joy Abbott
(J)
James Armstrong
(J)
Natalie Cooper
(N)
Lindsay Crate
(L)
John Emery
(J)
Kathryn James
(K)
Hannah King
(H)
Paul Martin
(P)
Stefano Scalia Catenacci
(S)
Rob Bomont
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Paul Smith
(P)
Sara Mele
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Alessandra Verzelloni
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Philippa Dix
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Graham Bell
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Elena Gordeva
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Lesley McKee
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Esther Ngan
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Jutta Scheffczik
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Li-En Tan
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Mark Worrall
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Carmel Cassar
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Kevin Goddard
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Vimmi Oshan
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Khairi Shah
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Sarah Bell
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Lisa Daniels
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Monica Gandhi
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David Pachter
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Chris Perry
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Andrew Robertson
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Lynne Waring
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Sophie Childs
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Joanne Norman
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Robin Sunderland
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Dowell Julia
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Feijten Prisca
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Harlet Pierre
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Herbineaux Sarah
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Leva Brigitte
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Virág Katalin
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