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BMJ Open. 2019 Nov 14;9(11):e034052. doi: 10.1136/bmjopen-2019-034052.

Premedication practices for tracheal intubation in neonates transported by French medical transport teams: a prospective observational study.

Author information

1
Service des Urgences Pédiatriques, Hôpital Trousseau, Paris, France ricardo.carbajal@trs.aphp.fr.
2
Médecine Sorbonne Université, INSERM UMR 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France.
3
Neonatal Transport Team, SMUR Pédiatrique, Hôpital Robert Debré, SAMU de Paris (AP-HP), Paris, France.
4
Neonatal Transport Team, SMUR Pédiatrique, SAMU de Seine Saint Denis (AP-HP), Montreuil, France.
5
Neonatal Transport Team, SMUR Pédiatrique Necker, Hôpital Necker, SAMU de Paris (AP-HP), Paris, France.
6
Neonatal Transport Team, SMUR Pédiatrique, SAMU du Val d'Oise, Pontoise, France.
7
Neonatal Transport Team, SMUR Pédiatrique, Hôpital Antoine Béclère, SAMU des Hauts de Seine, Hôpitaux Universitaires Paris-Sud (AP-HP), Clamart, Hauts de Seine, France.
8
Paediatric Emergency Department, Assitance Publique-Hôpitaux de Paris, Paris, France.
9
INSERM UMR 1153 Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France.
10
Centre National de Ressources de Lutte Contre la Douleur, Hopital Armand Trousseau, Paris, France.

Abstract

OBJECTIVES:

Premedication practices for neonatal tracheal intubations have not yet been described for neonatal transport teams. Our objective is to describe the use of sedation/analgesia (SA) for tracheal intubations and to assess its tolerance in neonates transported by medical transport teams in France.

SETTING:

This prospective observational study was part of the EPIPPAIN 2 project and collected around-the-clock data on SA practices in neonates intubated by all five paediatric medical transport teams of the Paris region during a 2-month period. Intubations were classified as emergent, semiemergent and non-emergent. Sedation level and conditions of intubation were assessed with the Tonus, Reactivity, Awareness and Conditions of intubation to Help in Endotracheal intubation Assessment (TRACHEA score). The scores range from 0 to 10 representing an increasing ladder from adequate to inadequate sedation, and from excellent to very poor conditions of intubation.

PARTICIPANTS:

40 neonates intubated in 28 different centres.

RESULTS:

The mean (SD) age was 34.9 (3.9) weeks, and 62.5% were intubated in the delivery room. 30/40 (75%) of intubations were performed with the use of SA. In 18/30 (60.0%) intubations performed with SA, the drug regimen was the association of sufentanil and midazolam. Atropine was given in 19/40 intubations. From the 16, 21 and 3 intubations classified as emergent, semiemergent and non-emergent, respectively, 8 (50%), 19 (90.5%) and 3 (100%) were performed with SA premedication. 79.3% of intubations performed with SA had TRACHEA scores of 3 or less. 22/40 (55%) infants had at least one of the following adverse events: muscle rigidity, bradycardia below 100/min, desaturation below 80% and nose or pharynx-larynx bleeding. 7/24 (29.2%) of those who had only one attempt presented at least one of these adverse events compared with 15/16 (93.8%) of those who needed two or more attempts (p<0.001).

CONCLUSION:

SA premedication is largely feasible for tracheal intubations performed in neonates transported by medical transport teams including intubations judged as emergent or semiemergent.

TRIAL REGISTRATION NUMBER:

NCT01346813; Results.

KEYWORDS:

epidemiology; intubation; neonatal intensive & critical care; neonatology; pain management

PMID:
31727669
DOI:
10.1136/bmjopen-2019-034052
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