Increasing Premedication for Neonatal Intubation: A Quality Improvement Initiative

Area of Science:

• Neonatal intensive care
• Clinical quality improvement
• Pediatric anesthesiology

Background:

• Endotracheal intubation in the NICU can cause distress and instability.
• Premedication is crucial for mitigating adverse effects like hypoxia, bradycardia, and pain.
• A quality improvement initiative aimed to increase premedication rates for nonemergent neonatal intubation.

Purpose of the Study:

• To increase the use of premedication for nonemergent neonatal endotracheal intubation.
• To improve patient outcomes by reducing distress and instability during intubation.
• To achieve a target of 80% premedication use from March 2021 to May 2023.

Main Methods:

• Quality improvement methodology and a key driver diagram were employed.
• Data collection included retrospective demographic analysis and outcome measures.
• Statistical analysis utilized Fisher's exact test for categorical variables.

Main Results:

• Premedication use increased from 22% to 52% among 130 intubated infants.
• Hypoxemic respiratory failure was the most common indication for intubation (52%).
• Intubation success on the first attempt showed no significant difference between groups (77.6% vs. 66.7%).

Conclusions:

• The initiative resulted in a 30% increase in premedication use, falling short of the 80% target.
• Implementing a premedication bundle and unit-specific protocols are key steps.
• Enhancing analgesia and sedation practices in the NICU requires a collaborative approach.