Predictors of challenging initial intubation and association with outcomes in congenital diaphragmatic hernia

To assess for differences in congenital diaphragmatic hernia patient characteristics between those requiring single or multiple intubation attempts, and to determine the relationship between number of intubation attempts and time to intubation with outcomes.

This was a retrospective cohort study of 205 infants with congenital diaphragmatic hernia born at Texas Children's Hospital. Patient demographics and severity numbers were compared to number of laryngoscopies as a surrogate for intubation attempts. Number of laryngoscopies and time to intubation were compared to clinical outcomes. Binary logistic regression and receiver operating characteristic curve analysis were used.

There was no significant difference in baseline characteristics or CDH severity in those requiring single or multiple attempts. Greater number of intubation attempts was not associated with adverse outcomes but there was a significant association between longer time to successful intubation and mortality and higher risk of tracheostomy or death before discharge. Each additional minute before successful intubation was associated with 28% higher odds of mortality (p = 0.031) and 42% higher odds of tracheostomy or death before discharge (p = 0.006) CONCLUSION: Delayed time to intubation but not number of intubation attempts was associated with higher mortality and risk of tracheostomy or death in babies with CDH. Prenatal information including receipt of the FETO procedure, CDH severity markers, gestational age and birth weight cannot reliably be used to predict the likelihood of challenging intubations in infants with CDH.