title: Factors Associated with Adverse Events during Tracheal Intubation in the NICU.
abstract: BACKGROUND
  The incidence of adverse tracheal intubation-associated events (TIAEs) and associated patient, practice, and intubator characteristics in the neonatal intensive care unit (NICU) setting are unknown.
  
  
  OBJECTIVE
  To determine the incidence of adverse TIAEs and to identify factors associated with TIAEs in the NICU.
  
  
  METHODS
  Single-site prospective observational cohort study of infants who were intubated in a level 4 referral NICU between September 1, 2011 and November 30, 2013. A standardized pediatric airway registry was implemented to document patient, practice, and intubator characteristics and outcomes of intubation encounters. The primary outcome was adverse TIAEs.
  
  
  RESULTS
  Adverse TIAEs occurred in 153 of 701 (22%) tracheal intubation encounters. Factors that were independently associated with lower incidence of TIAEs in logistic regression included attending physician (vs. resident; odds ratio (OR) 0.4, 95% CI: 0.16, 0.98) and use of paralytic medication (OR 0.45, 95% CI: 0.25, 0.81). Severe oxygen desaturations (≥ 20% decrease in oxygen saturation) occurred in 51.1% of encounters and were more common in tracheal intubations performed by residents (62.8%), compared to fellows (43.2%) or attendings (47.5%; p = 0.008).
  
  
  CONCLUSIONS
  Adverse TIAEs and severe oxygen desaturation events are common in the NICU setting. Modifiable risk factors associated with TIAEs identified include intubator training level and use of paralytic medications.
authors.affiliation: Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pa., USA.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Foglia
authors.forename: Anne
authors.initials: A
authors.lastname: Ades
authors.forename: Natalie
authors.initials: N
authors.lastname: Napolitano
authors.forename: Jessica
authors.initials: J
authors.lastname: Leffelman
authors.forename: Vinay
authors.initials: V
authors.lastname: Nadkarni
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D010100:Oxygen / Q000378:metabolism*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D010100:Oxygen