437 - Cerebral Oxygenation During Neonatal Intubation

Poster Number: 437
Publication Number: 437.227

Ellyn C. Van Der Veeken, The Royal Women's Hospital, IVANHOE, Victoria, Australia; Brett J. Manley, The Royal Women's Hospital, Melbourne, Victoria, Australia; Peter G. Davis, University of Melbourne, Melbourne, Victoria, Australia; Rocco Cuzzilla, Royal Women's Hospital, Parkville, Victoria, Australia; Kate A. Hodgson, Royal Women's Hospital, Parkville, Victoria, Australia

Background: Neonatal endotracheal intubation is a difficult skill to learn, first attempt success rates are decreasing over time and infants are often unstable during the procedure. Nasal high-flow therapy (nHF) may prolong the time to desaturation during intubation. Near-Infrared Spectroscopy (NIRS) is a non-invasive technique used to continuously monitor tissue oxygenation, including cerebral oxygenation, at the bedside. No previous studies have examined the effect of nHF on cerebral oxygenation during neonatal intubation.

Objective: To compare the difference from baseline in mean regional cerebral oxygen saturation (rScO2) between neonates receiving nHF during endotracheal intubation and those receiving standard care (no nHF).

Design/Methods: This was a sub-study of a randomised controlled trial of the use of nHF during neonatal intubation. A subset comprising 19 of the 258 randomised intubation attempts had NIRS monitoring. The procedure was video recorded, and peripheral oxygen saturation, heart rate and rScO2 (NIRS) were extracted at baseline (time zero (t0) when the laryngoscope first touched the infant’s lips) and every 2 seconds thereafter until the first attempt was successful or abandoned (when the laryngoscope exited the mouth). The absolute difference from baseline of rScO2 was calculated every 2 seconds after t0 to derive the mean difference from baseline.

Results: There were eleven infants in the nHF group and eight infants in the standard care group. Regional cerebral oxygen saturation fell more slowly in the nHF group compared with infants receiving standard care. The median (interquartile range) of the mean difference from baseline of rScO2 was -1.4% (-5.1% to 0%) in infants in the nHF group compared with -8.7% (-18.7% to -4.3%) in infants in the standard care group (p=0.005). The median (interquartile range) rate of change of rScO2 was -0.08 (-0.13 – 0.00) %/sec in infants in the nHF group compared with -0.36 (-0.66 – -0.21) %/sec in infants in the standard care group (p=0.004).Conclusion(s): Infants who received nHF during endotracheal intubation had more stable rScO2 than infants who did not. Further investigation of this relationship is required in a larger cohort of infants to confirm this apparent benefit.
Field of view captured by the GoPro including all equipment used
Cerebral and peripheral oxygenation saturation over time for an infant who received standard care (no nasal high-flow) and an infant who received nasal high-flow during their first intubation attempt.The infant who received nasal high-flow maintained a stable cerebral and peripheral oxygen saturation over their first intubation attempt. The infant who received standard care decreased in their cerebral and peripheral oxygen saturation over time.