Clinical Research Pathway

Critical Care

Neonatology

Pulmonology

Scholarly Sessions

2570 - The Great Escape: Steering Away from the Endotracheal Tube in the Extremely Preterm Infant

Chair(s)

• 

  Guilherme Sant'Anna, MD, PhD (he/him/his)

  Full Professor of Pediatrics, Neonatal Division
  McGill University Health Center
  MONTREAL, Quebec, Canada
• WS

  Wissam Shalish, MD, PhD

  Neonatologist
  Division of Neonatology, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada
  Montreal, Quebec, Canada

Exposure to intubation and mechanical ventilation is well recognized as an important contributor to increased short and long-term morbidities in extremely preterm infants, including bronchopulmonary dysplasia and neurodevelopmental impairment. Despite a rise in non-invasive respiratory support use, mechanical ventilation remains an integral component of the respiratory care of most infants born extremely preterm today. In an attempt to curtail mechanical ventilation use in this population, various strategies have been evaluated in research studies and/or adopted in clinical practice. These strategies typically fall into one of four categories: (1) to promote a gentle approach in the delivery room through evidence-based interventions and optimal intubation practices, (2) to prevent the need for mechanical ventilation in the NICU through different non-invasive respiratory support modalities and less-invasive methods for surfactant administration, (3) to expedite weaning and extubation using adjuvant therapies and extubation readiness tests, and (4) to prevent reintubation post-extubation through various non-invasive respiratory support modalities. Integration of these strategies is key to reducing mechanical ventilation exposure in this vulnerable population.

In this Panel Discussion, a group of international experts spanning diverse career stages will review the current realities of mechanical ventilation in extremely preterm infants and critically appraise the strategies used to promote a gentle postnatal transition in the delivery room, to prevent intubation and mechanical ventilation, to expedite extubation, and to avoid reintubation. Throughout this session, the shortcomings of the different strategies intended to reduce the burden of mechanical ventilation will be highlighted and weighed against the cost of mechanical ventilation exposure.

Presentations:

• 1:00 PM – 1:10 PM US MT

  Introduction
  

  Co-Leader: Guilherme Sant'Anna, MD, PhD, FRCPC – McGill University Health Center
• 1:00 PM – 1:15 PM US MT

  Off to a great start: Optimizing delivery room interventions and minimizing harm from endotracheal intubation
  

  Speaker: Elizabeth Foglia, MD, MSCE – Perelman School of Medicine at the University of Pennsylvania
• 1:15 PM – 1:30 PM US MT

  Preventing intubation and mechanical ventilation: Strategies and words of caution
  

  Speaker: Daniele De Luca, MD, PhD – Paris Saclay University
• 1:30 PM – 1:45 PM US MT

  Expediting extubation: How and at what cost?
  

  Speaker: Wissam Shalish, MD, PhD – McGill University Health Center
• 1:45 PM – 2:00 PM US MT

  Hanging on tightly on non-invasive respiratory support: current reality, gaps and future directions
  

  Speaker: Clyde Wright, MD – University of Colorado School of Medicine
• 2:10 PM – 2:30 PM US MT

  Q & A
  

  Speaker: Guilherme Sant'Anna, MD, PhD, FRCPC – McGill University Health Center