A Novel Cause of Error in Capnographic Confirmation of Intubation in the Neonatal Intensive Care Unit

PEDIATRICS ◽  
1995 ◽  
Vol 95 (1) ◽  
pp. 140-142
Author(s):  
William A. Roberts ◽  
William M. Maniscalco
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Endotracheal Intubation ◽  
Neonatal Intensive Care ◽  
Routine Care ◽  
Esophageal Intubation ◽  
Neurologic Injury ◽  
Clinical Indicators ◽  
Clinical Criteria ◽  
Cause Of Error

Failure to recognize esophageal intubation can result in hypoxia and may lead to permanent neurologic injury. Clinical criteria commonly used to comfirm endotracheal intubation can fail to identify esophageal misplacement.1-9 The risk of this error has been reduced in the operating room by using capnography, which is both sensitive and specific for correct endotracheal intubation.4,6,7,10-12 Capnography is able to identify errant tube placements more rapidly and specifically than clinical indicators alone.10 We report here a novel cause of error in the capnographic findings at intubation in a neonate. CASE REPORT A 26-week gestational age, 690-g neonate was accidentally extubated during routine care.

General Anesthesia with Endotracheal Intubation for Cryotherapy for Retinopathy of Prematurity

1995 ◽  
Vol 5 (3) ◽  
pp. 187-191 ◽  
Author(s):  
T.J. Sullivan ◽  
M.P. Clarke ◽  
R. Tuli ◽  
R. Devenyi ◽  
P. Harvey
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Retinopathy Of Prematurity ◽  
Neonatal Intensive Care ◽  
Minimal Risk ◽  
Systemic Complications ◽  
Mean Time

We present a technique for treating retinopathy of prematurity (ROP) with cryotherapy under general anesthesia, administered and monitored by a neonatologist, with endotracheal intubation in the neonatal intensive care unit that avoids the serious systemic complications associated with the administration of local anesthetics. Although no significant complications arose in this series, having the intubated infant monitored by trained neonatology staff allows appropriate management should complications arise. We have used this technique to treat 20 eyes with threshold ROP. The mean time to extubation was 40.2 hours. The systemic status and discharge from the neonatal intensive care unit were not influenced by the general anesthesia. This technique allows quick and accurate application of the cryotherapy in a stable and controlled setting. We recommend that physicians consider cryotherapy under general anesthesia with endotracheal intubation for infants with ROP. This technique allows ROP to be treated adequately with minimal risk to the infant.

scholarly journals Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051989477 ◽  
Author(s):  
Weiting Chen ◽  
Junbo Chen ◽  
Hehao Wang ◽  
Yingzi Chen
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Real Time ◽  
Endotracheal Intubation ◽  
Fiberoptic Bronchoscopy ◽  
Esophageal Intubation ◽  
Predictive Values ◽  
Kappa Value ◽  
Life Threatening ◽  
Sensitivity Specificity

Objective Critically ill patients often require emergency endotracheal intubation and mechanical ventilation. When esophageal intubation is not confirmed early, treatment may be delayed, even for life-threatening conditions. We examined the accuracy of bedside real-time airway ultrasonography in confirming the endotracheal tube (ETT) position during emergency endotracheal intubation in patients in the intensive care unit (ICU). Methods This single-center prospective observational study included 118 patients who underwent urgent endotracheal intubation in the ICU of Taizhou Hospital of Integrated Traditional Chinese and Western Medicine. Tracheal ultrasonography was used to confirm the ETT position during endotracheal intubation, after which fiberoptic bronchoscopy was performed. The accuracy of bedside real-time tracheal ultrasonography in determining the ETT position was examined. Results Twelve (10.2%) patients underwent endotracheal intubation. The kappa value was 0.844, indicating perfect consistency between tracheal ultrasonography and fiberoptic bronchoscopy in identifying esophageal intubation. The sensitivity, specificity, and positive and negative predictive values of tracheal ultrasonography in determining the ETT position were 75.0%, 100%, 100%, and 97.2%, respectively. Conclusions Bedside real-time tracheal ultrasonography accurately assesses the ETT position in the ICU and can identify the ETT position during intubation. These findings have important clinical applications and are of great significance for treatment of ICU patients.

The use of capnography for recognition of esophageal intubation in the neonatal intensive care unit

1995 ◽  
Vol 19 (5) ◽  
pp. 262-268 ◽  
Author(s):  
William A. Roberts ◽  
William M. Maniscalco ◽  
A. Ross Cohen ◽  
Ronald S. Litman ◽  
Ashwani Chhibber
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Esophageal Intubation

Risk Factors for Neonatal Acquired Subglottic Stenosis

1986 ◽  
Vol 95 (6) ◽  
pp. 626-630 ◽  
Author(s):  
Steven K. Dankle ◽  
David E. Schuller ◽  
Richard E. McClead
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Airway Management ◽  
Endotracheal Intubation ◽  
Neonatal Intensive Care ◽  
Effective Means ◽  
Assisted Ventilation ◽  
Subglottic Stenosis ◽  
Prolonged Intubation

Endotracheal intubation has proven to be a relatively safe and effective means of securing the airway in neonates. Some concern remains, however, regarding airway management in critically ill infants who require assisted ventilation for extended periods. Among the various risk factors associated with the complication of acquired subglottic stenosis in neonates, the one most frequently cited has been “prolonged” intubation, although opinion varies regarding the definition of this term. Various recommendations exist that attempt to establish the limits of “safe” periods of intubation for infants. Some feel that tracheotomy is indicated when airway support is required beyond those limits. In an attempt to define important risk factors involved in the development of neonatal subglottic stenosis, a retrospective analysis of infants admitted to the Neonatal Intensive Care Unit of Columbus Children's Hospital who required intubation during a 3-year period from 1977 to 1980 was undertaken. Of 343 infants who survived hospitalization, five patients were identified as having acquired subglottic stenosis. The average duration of intubation for these five patients was 56.2 days. The incidence of subglottic stenosis for infants whose duration of intubation ranged from 3 to 50 days was 0.4% (1/245). Infants with birth weights less than 1,500 g appeared more susceptible to the development of intubation-related laryngeal injury. The conclusion of this study is that endotracheal intubation is an appropriate means of long-term airway management in neonates hospitalized in a pediatric intensive care unit, providing other known risk factors are minimized.

Evaluation the Effect of Co-Bedding Premature Twin or Multiple Birth Infants on their Growth, Physiological Stability, and Short-Term Prognosis in Nicus

2021 ◽  
Vol 15 (8) ◽  
pp. 2346-2349
Author(s):  
Mina Salimi ◽  
Somaye Jafari ◽  
Arash Bordbar ◽  
Maryam Saboute ◽  
Mandana Kashaki
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Weight Gain ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Arterial Oxygen Saturation ◽  
Routine Care ◽  
Arterial Oxygen ◽  
Multiple Birth ◽  
Significant Difference

The aim of this study was to investigate the effect of co-bedding among premature twin or multiple birth infants on their growth and physiological stability. In this randomized clinical trial, a total number of 80 pairs of premature twin or multiple birth infants hospitalized in the neonatal intensive care unit (NICU) of Shahid Akbar-Abadi Hospital in Tehran, Iran, were randomly allocated into two groups; co-bedded and routine care. The required data were collected through a demographic characteristics information questionnaire and a co-bedding checklist and compared between groups. In the following, data analysis showed that the weight gain and mean of NICU hospitalization days in the co-bedded group were significantly different from those in the standard care infants (P<0.001). However; there was no significant difference in terms of increase in height (P=0.1), head circumference (P=0.4), heart rate (P=0.3), arterial oxygen saturation (P=0.12), and respiratory rate (P=0.68) between groups. It was concluded that co-bedding twin or multiple birth infants could lead to weight gain among them and consequently accelerate their recovery and discharge. Keywords: co-bedding, premature multiple births, neonatal intensive care unit

The Psychosocial Aspects of Feeding in the Neonatal Intensive Care Unit and Beyond

2019 ◽  
Vol 4 (6) ◽  
pp. 1507-1515
Author(s):  
Lauren L. Madhoun ◽  
Robert Dempster
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Hospital Discharge ◽  
Neonatal Intensive Care ◽  
Oral Feeding ◽  
Medical Attention ◽  
Primary Role ◽  
Speech Language Pathologists ◽  
The Family

Purpose Feeding challenges are common for infants in the neonatal intensive care unit (NICU). While sufficient oral feeding is typically a goal during NICU admission, this can be a long and complicated process for both the infant and the family. Many of the stressors related to feeding persist long after hospital discharge, which results in the parents taking the primary role of navigating the infant's course to ensure continued feeding success. This is in addition to dealing with the psychological impact of having a child requiring increased medical attention and the need to continue to fulfill the demands at home. In this clinical focus article, we examine 3 main areas that impact psychosocial stress among parents with infants in the NICU and following discharge: parenting, feeding, and supports. Implications for speech-language pathologists working with these infants and their families are discussed. A case example is also included to describe the treatment course of an infant and her parents in the NICU and after graduation to demonstrate these points further. Conclusion Speech-language pathologists working with infants in the NICU and following hospital discharge must realize the family context and psychosocial considerations that impact feeding progression. Understanding these factors may improve parental engagement to more effectively tailor treatment approaches to meet the needs of the child and family.

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