Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study. (June 2021)

• Record Type: Journal Article
• Authors: Disma, Nicola; Virag, Katalin; Riva, Thomas; Kaufmann, Jost; Engelhardt, Thomas; Habre, Walid; Breschan, Christian; Likar, Rudolf; Platzer, Manuela; Edelman, Isole; Eger, Johanes; Heschl, Stefan; Messerer, Brigitte; Vittinghof, Maria; Kroess, Ruth; Stichlberger, Martina; Kahn, David; Pirotte, Thierry; Pregardien, Caroline; Veyckemans, Francis; Stevens, France; Berghmans, Johan; Bauters, Annemie; De Baerdemaeker, Luc; De Hert, Stefan; Lapage, Koen; Parashchanka, Aliaksandra; Van Limmen, Jurgen; Wyffels, Piet; Lauweryns, Julie; Najafi, Nadia; Vundelinckx, Joris; Butković, Diana; Kerovec Sorić, Ivana; Kralik, Sandra; Markić, Ana; Azman, Josip; Markic, Josko; Pupacic, Daniela; Frelich, Michal; Reimer, Petr; Urbanec, René; Cajková, Petra; Mixa, Vladimír; Sedláčková, Yvona; Knoppová, Lenka; Zlámalová (neé Květoňová), Alena; Vavřina, Martin; Žurek, Jiří; Hansen, Tom; Afshari, Arash; Bille, Anders Bastholm; Ellekvist, Marguerite; Ilmoja, Mari-Liis; Moor, Reet; Kikas, Reet; Väli, Merle; Kallio, Kariantti; Reponen, Elisa; Suominen, Pertti; Suvanto, Sami; Vähätalo, Raisa; Kokki, Hannu; Kokki, Merja; Harju, Jarkko; Kokkonen, Miia; Vieri, Jenni; Manner, Tuula; Amory, Catherine; Ludot, Hugues; Bert, Dina; Godart, Juliette; Laffargue, Anne; Dupont, Hervé; Urbina, Benjamin; Baujard, Catherine; Roulleau, Philippe; Staiti, Giuseppe; Bordes, Maryline; Nouette Gaulain, Karine; Hamonic, Yann; Semjen, François; Jacqmarcq, Olivier; Lejus-Bourdeau, Caroline; Magne, Cécile; Petry, Léa; Ros, Lilica; Zang, Aurélien; Bennis, Mehdi; Coustets, Bernard; Fesseau, Rose; Constant, Isabelle; Khalil, Eliane; Sabourdin, Nada; Audren, Noemie; Descarpentries, Thomas; Fabre, Fanny; Legrand, Aurélien; Druot, Emilie; Orliaguet, Gilles; Sabau, Lucie; Uhrig, Lynn; de la Brière, François; Jonckheer, Karin; Mission, Jean-Paul; Scordo, Lucia; Couchepin, Caroline; Dadure, Christophe; De la Arena, Pablo; Hertz, Laurent; Pirat, Philippe; Sola, Chrystelle; Bellon, Myriam; Dahmani, Souhayl; Julien-Marsollier, Florence; Michelet, Daphne; Depret-Donatien, Veronique; Lesage, Anne; Kaufmann, Jost; Laschat, Michael; Wappler, Frank; Becke, Karin; Brunner, Lena; Oppenrieder, Karin; Badelt, Gregor; Hochmuth, Karin; Koller, Bernhard; Reil, Anita; Richter, Sebastian; Fischer, Thomas; Diers, Anja; Schorer, Clemens; Weyland, Andreas; Cohausz, Ruth; Kretz, Franz-Josef; Löffler, Michaela; Wilbs, Markus; Hoehne, Claudia; Ulrici, Johanna; Goeters, Christiane; Flinspach, Armin; Klages, Matthias; Lindau, Simone; Messroghli, Leila; Zacharowski, Kai; Eisner, Christoph; Mueller, Thomas; Richter, Daniel; Schäfer, Melanie; Weigand, Markus; Weiterer, Sebastian; Ochsenreiter, Miriam; Schöler, Michael; Terboven, Tom; Eggemann, Isabel; Haussmann, Sascha; Leister, Nicolas; Menzel, Christoph; Trieschmann, Uwe; Yücetepe, Sirin; Keilig, Susanna; Kranke, Peter; Jelting, Yvonne; Baehner, Torsten; Ellerkmann, Richard; Ghamari, Shahab; Neumann, Claudia; Söhle, Martin; Chloropoulou, Pelagia; Ntritsou, Vagia; Papagiannopoulou, Pinelopi; Garini, Eleana; Karafotia, Afroditi; Mammi, Panagoula; Bali, Evangelia; Iordanidou, Despoina; Malisiova, Anna; Polyzoi, Artemis; Tsiotou, Adelais; Sapi, Erzsebet; Székely, Edgar; Kosik, Nandor; Maráczi, Veronika; Schnur, Janos; Csillag, Judit; Gál, János; Göbl, Gergely; Hauser, Balázs; Petróczy, András; Tövisházi, Gyula; Blain, Stuart; Gallagher, Sarah; Harte, Sinead; Jackson, Mandy; Meehan, Emma; Nawoor, Zeenat; O'Hare, Brendan; Ross, Mark; Lerro, Daniela; Astuto, Marinella; Grasso, Chiara; Scalisi, Rita; Frasacco, Giulia; Lenares, Elena; Leone, Roberto; Grazzini, Maurizia; Minardi, Carmelo; Zadra, Nicola; Cinnella, Gilda; Cotoia, Antonella; Galante, Dario; De Lorenzo, Brita; Kuppers, Beate; Bottazzi, Giulia; Caramelli, Fabio; Mondardini, Maria Cristina; Rossetti, Emanuele; Picardo, Sergio; Vittori, Alessandro; Camporesi, Anna; Wolfler, Andrea; Calderini, Edoardo; Colantonio, Laura Brigitta; Finamore, Simona Anna; Porro, Giuliana Anna; Bonfiglio, Rachele; Disma, Nicola; Kotzeva, Svetlana; Mameli, Leila; Mattioli, Girolamo; Micalizzi, Camilla; Montaguti, Alessia; Pistorio, Angela; Zanaboni, Clelia; Guddo, Anna; Neba, Gerald Rogan; Favarato, Moreno; Locatelli, Bruno Guido; Maffioletti, Micol; Sonzogni, Valter; Garra, Rossella; Sammartino, Maria; Sbaraglia, Fabio; Cortegiani, Andrea; Moscarelli, Alessandra; Attanasi, Elena; Tesoro, Simonetta; Agapiti, Cristina; Pinzoni, Francesca; Vezzoli, Cesare; Bilotta, Federico; Barzdina, Arta; Straume, Zane; Zundane, Anda; Lukosiene, Laura; Maraulaite, Irena; Razlevice, Ilona; Schmitz, Bernd; Mifsud, Stephanie; Aehling, Carolin; Allison, Celia; De Boer, Rients; Emal, Dina; Stevens, Markus; Buitenhuis, Marielle; de Graaff, Jurgen; De Liefde, Inge; Machotta, Andreas; Scoones, Gail; Staals, Lonneke; Tomas, Jeremy; Van der Knijff-van Dortmont, Anouk; Veldhuizen, Marianne; Alders, David; Buhre, Wolfgang; Schafrat, Eva; Schreiber, Jan; Vermeulen, Petronella Mari; Hendriks, Mark; Lako, Sandra; Voet-Lindner, Marieke; Pieters, Barbe; Scheffer, Gert-Jan; Tielens, Luc; Absalom, Anthony R.; Bergsma, Margot; De Ruiter, Joke; Meier, Sascha; Volkers, Martin; Zweers, Tjerk; Beukers, Anne M.; Boer, Christa; Dertinger, Jurgen; Numan, Sandra; Van Zaane, Bas; Boerke, Wenche B.; Ekiz, Nil; Stensrud, Kristoffer; Drage, Inger Marie; Isern, Erik Ramon; Bartkowska-Sniatkowska, Alicja; Grzeskowiak, Malgorzata; Juzwa-Sobieraj, Magdalena; Rosada-Kurasińska, Jowita; Baranowski, Artur; Jakubowska, Karina; Lewandowska, Dorota; Mierzewska-Schmidt, Magdalena; Sawicki, Piotr; Urban-Lechowicz, Magdalena; Przemyslaw, Pomianek; Zielinska, Marzena; Leal, Teresa; Soares, Maria; Pina, Pedro; Pinho, Sílvia; Patuleia, Maria Domingas; Esteves, Catarina Cruz; Salgado, Helena; Santos, Maria João; Badeti, Rodica; Cindea, Iulia; Oana, Loredana; Gurita, Adriana; Ilie, Luminita; Mocioiu, Gabriel; Tabacaru, Radu; Trante, Irina; Munteanu, Valentin; Morariu, Mihai; Nyíri, Emese; Budic, Ivana; Marjanovic, Vesna; Drašković, Biljana; Pandurov, Marina; Ilic, Jordanka; Mandras, Ana; Rados, Zdenka; Stankovic, Nikola; Suica, Maja; Vasiljevic, Sladjana; Knezevic, Mirjana; Milojevic, Irina; Petrov, Ivana; Puric Racic, Selena; Simic, Dusica; Simic, Irena; Stevic, Marija; Vulicevic, Irena; Cabanová, Barbora; Hanula, Miloslav; Berger, Jelena; Janjatovic, Darja; Pirtovšek Štupnik, Špela; Méndez, Dolores; Pino, Gema; Rubio, Paloma; Izquierdo, Alberto; López, Silvia; González Serrano, Cristina; Cebrián, Jesús; Peleteiro, Ana; Del Rey de Diego, Pilar; Martínez García, Ernesto; Tormo de las Heras, Carolina; Troncoso Montero, Pablo; Arbona, Celia; Artés, David; Chamizo, Alicia; Serrano, Silvia; Suarez Comas, Montserrat; Escribá, Francisco; Auli, Cristina; Pérez Pardo, Osvaldo; Sierra Biddle, Natalia; Suárez Castaño, Ceferina; Villalobos Rico, María Isabel; Manrique Muñoz, Susana; García Martínez, Irene; Montferrer Estruch, Nuria; Vilardell Ortíz, Elena; Poves-Álvarez, Rodrigo; Kohn, Ivan; Lindestam, Ulf; Reinhard, Jarl; Castellheim, Albert; Sandström, Kerstin; Bengt, Sporre; Dörenberg, Rainer; Frykholm, Peter; Garcia, Maria; Kvarnström, Ann; Pontén, Emma; Bruelisauer, Thomas; Erdoes, Gabor; Kaiser, Heiko; Marchon, Mathias; Riva, Thomas; Seiler, Stefan; Bögli, Yann; Dolci, Mirko; Marcucci, Carine; Habre, Walid; Pichon, Isabelle; Vutskits, Laszlo; Casutt, Mattias; Hölzle, Martin; Hurni, Thomas; Jöhr, Martin; Malär, Anna-Ursina; Mauch, Jacqueline; Erb, Thomas; Oeinck, Karin; Akin, Mine; Keskin, Gulsen; Senayli, Yesim; Kaya, Guner; Kendigelen, Pinar; Tutuncu, Ayse Çiğdem; Hatipoğlu, Zehra; Özcengiz, Dilek; Erdost, Hale Aksu; Öçmen, Elvan; Olguner, Çimen; Ayanoglu, Hilmi; Dincer, Pelin Corman; Umuroglu, Tumay; Azizoglu, Mustafa; Birbiçer, Handan; Doruk, Nurcan; Sagun, Aslı; Baris, Sibel; Dmytriiev, Dmytro; Kuchi, Sridevi; Masip, Nuria; Brooks, Peter; Hare, Alison; Ahmad, Nargis; Casey, Michelle; De Silva, Sam; Dobby, Nadine; Krishnan, Prakash; Sogbodjor, L. Amaki; Walker, Ellie; Walker, Suellen; King, Stephanie; Nicholson, Katy; Quinney, Michelle; Stevens, Paul; Blevin, Andrew; Giombini, Mariangela; Goonasekera, Chulananda; Adil, Sadia; Bew, Stephanie; Bodlani, Carol; Gilpin, Dan; Jinks, Stephanie; Malarkkan, Nalini; Miskovic, Alice; Pad, Rebecca; Wolfe Barry, Juliet; Abbott, Joy; Armstrong, James; Cooper, Natalie; Crate, Lindsay; Emery, John; James, Kathryn; King, Hannah; Martin, Paul; Scalia Catenacci, Stefano; Bomont, Rob; Smith, Paul; Mele, Sara; Verzelloni, Alessandra; Dix, Philippa; Bell, Graham; Gordeva, Elena; McKee, Lesley; Ngan, Esther; Scheffczik, Jutta; Tan, Li-En; Worrall, Mark; Cassar, Carmel; Goddard, Kevin; Barlow, Victoria; Oshan, Vimmi; Shah, Khairi; Bell, Sarah; Daniels, Lisa; Gandhi, Monica; Pachter, David; Perry, Chris; Robertson, Andrew; Scott, Carmen; Waring, Lynne; Barnes, David; Childs, Sophie; Norman, Joanne; Sunderland, Robin; Julia, Dowell; Prisca, Feijten; Pierre, Harlet; Sarah, Herbineaux; Brigitte, Leva; Benoît, Plichon; Katalin, Virág;
• Is Part Of: British journal of anaesthesia. Volume 126:Number 6(2021)
• Page Start: 1173
• Page End: 1181
• Publication Date: 2021-06
• Subjects: airways -- anaesthesia -- difficult intubation -- infants -- morbidity -- mortality -- neonates -- paediatric; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2021.02.021
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: 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: 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: 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 (SpO2 <90% for 60 s) was reported in 40%. No associated risk factors could be identified among co-morbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. 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: NCT02350348.