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Strategies to Improve Neonatal Intubation Safety by Preventing Endobronchial Placement of the Tracheal Tube—Literature Review and Experience at a Tertiary Center

Unintended endobronchial placement is a common complication of neonatal tracheal intubation and a threat to patient safety, but it has received little attention towards decreasing its incidence and mitigating associated harms. We report on the key aspects of a long-term project in which we applied p...

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Autores principales: Pinheiro, Joaquim M. B., Munshi, Upender K., Chowdhry, Rehman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9955846/
https://www.ncbi.nlm.nih.gov/pubmed/36832490
http://dx.doi.org/10.3390/children10020361
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author Pinheiro, Joaquim M. B.
Munshi, Upender K.
Chowdhry, Rehman
author_facet Pinheiro, Joaquim M. B.
Munshi, Upender K.
Chowdhry, Rehman
author_sort Pinheiro, Joaquim M. B.
collection PubMed
description Unintended endobronchial placement is a common complication of neonatal tracheal intubation and a threat to patient safety, but it has received little attention towards decreasing its incidence and mitigating associated harms. We report on the key aspects of a long-term project in which we applied principles of patient safety to design and implement safeguards and establish a safety culture, aiming to decrease the rate of deep intubation (beyond T3) in neonates to <10%. Results from 5745 consecutive intubations revealed a 47% incidence of deep tube placement at baseline, which decreased to 10–15% after initial interventions and remained in the 9–20% range for the past 15 years; concurrently, rates of deep intubation at referring institutions have remained high. Root cause analyses revealed multiple contributing factors, so countermeasures specifically aimed at improving intubation safety should be applied before, during, and immediately after tube insertion. Extensive literature review, concordant with our experience, suggests that pre-specifying the expected tube depth before intubation is the most effective and simple intervention, although further research is needed to establish accurate and accepted standards for estimating the expected depth. Presently, team training on intubation safety, plus possible technological advances, offer additional options for safer neonatal intubations.
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spelling pubmed-99558462023-02-25 Strategies to Improve Neonatal Intubation Safety by Preventing Endobronchial Placement of the Tracheal Tube—Literature Review and Experience at a Tertiary Center Pinheiro, Joaquim M. B. Munshi, Upender K. Chowdhry, Rehman Children (Basel) Article Unintended endobronchial placement is a common complication of neonatal tracheal intubation and a threat to patient safety, but it has received little attention towards decreasing its incidence and mitigating associated harms. We report on the key aspects of a long-term project in which we applied principles of patient safety to design and implement safeguards and establish a safety culture, aiming to decrease the rate of deep intubation (beyond T3) in neonates to <10%. Results from 5745 consecutive intubations revealed a 47% incidence of deep tube placement at baseline, which decreased to 10–15% after initial interventions and remained in the 9–20% range for the past 15 years; concurrently, rates of deep intubation at referring institutions have remained high. Root cause analyses revealed multiple contributing factors, so countermeasures specifically aimed at improving intubation safety should be applied before, during, and immediately after tube insertion. Extensive literature review, concordant with our experience, suggests that pre-specifying the expected tube depth before intubation is the most effective and simple intervention, although further research is needed to establish accurate and accepted standards for estimating the expected depth. Presently, team training on intubation safety, plus possible technological advances, offer additional options for safer neonatal intubations. MDPI 2023-02-11 /pmc/articles/PMC9955846/ /pubmed/36832490 http://dx.doi.org/10.3390/children10020361 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pinheiro, Joaquim M. B.
Munshi, Upender K.
Chowdhry, Rehman
Strategies to Improve Neonatal Intubation Safety by Preventing Endobronchial Placement of the Tracheal Tube—Literature Review and Experience at a Tertiary Center
title Strategies to Improve Neonatal Intubation Safety by Preventing Endobronchial Placement of the Tracheal Tube—Literature Review and Experience at a Tertiary Center
title_full Strategies to Improve Neonatal Intubation Safety by Preventing Endobronchial Placement of the Tracheal Tube—Literature Review and Experience at a Tertiary Center
title_fullStr Strategies to Improve Neonatal Intubation Safety by Preventing Endobronchial Placement of the Tracheal Tube—Literature Review and Experience at a Tertiary Center
title_full_unstemmed Strategies to Improve Neonatal Intubation Safety by Preventing Endobronchial Placement of the Tracheal Tube—Literature Review and Experience at a Tertiary Center
title_short Strategies to Improve Neonatal Intubation Safety by Preventing Endobronchial Placement of the Tracheal Tube—Literature Review and Experience at a Tertiary Center
title_sort strategies to improve neonatal intubation safety by preventing endobronchial placement of the tracheal tube—literature review and experience at a tertiary center
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9955846/
https://www.ncbi.nlm.nih.gov/pubmed/36832490
http://dx.doi.org/10.3390/children10020361
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