Non-Invasive respiratory support during elective intubation in preterm infants-a randomized controlled trial

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Respiratory Physiology

Background:

• Neonatal intubation success rates are suboptimal and may be improved by apneic oxygenation.
• Preterm infants often require intubation while already on non-invasive respiratory support (NIPPV/CPAP).
• Maintaining non-invasive ventilation during intubation in neonates is not well-studied but offers potential benefits.

Purpose of the Study:

• To assess the feasibility, safety, and efficacy of using non-invasive ventilation via a soft nasal cannula during preterm infant intubation.
• To determine if this approach improves first-attempt intubation success without causing physiological instability.

Main Methods:

• A randomized controlled trial involving preterm infants on NIPPV or CPAP requiring elective intubation.
• Infants were randomized to either maintain non-invasive support (intervention) or undergo intubation without support (control).
• Primary outcome: successful first-attempt intubation without significant desaturation or bradycardia.

Main Results:

• First-attempt success without instability was significantly higher in the intervention group (51.79%) vs. control (28.57%).
• The intervention group showed reduced desaturation rates, longer time to desaturation, and shorter durations of desaturation and bradycardia.
• Efficacy was greater in infants weighing ≤1000g and with a SpO2/FiO2 ratio <1.5.

Conclusions:

• Continuing pre-existing non-invasive respiratory support via nasal cannula during intubation is feasible and safe.
• This strategy enhances first-attempt intubation success rates in preterm infants.
• The method improves physiological stability during the procedure.