![[ Visit Client Website ]](images/banner.gif)
Sunday, November 1, 2009
Learning Objective 1: list adverse physiologic effects of intubation in the neonate.
Learning Objective 2: discuss the efficacy and safety of premedication prior to intubation in the NICU.
Introduction
Intubation is a painful and stressful procedure frequently performed in the NICU. This procedure may cause bradycardia, hypoxemia, and apnea. Few health care providers would consider intubating an adult or a young child without supporting pharmacologic measures, yet less than 1% of preterm infants in the NICUs of the United States receive premedication prior to this procedure. The purpose of this study is to evaluate the efficacy and safety of a change in the intubation protocol in one NICU in a teaching hospital in the eastern U.S. The protocol involves the administration of 1 dose (2mcg/kg) of Fentanyl to all infants prior to elective or semi-urgent intubation.
The evaluation will determine the efficacy of the protocol in: 1) increasing staff knowledge regarding neonatal procedural pain, 2) reducing the incidence of adverse physiologic effects (bradycardia and desaturations), 3) reducing the time to successful intubation and, 4) reducing the number of intubation attempts per neonate.
Methods
All staff involved in intubation procedures will attend one education session addressing neonatal procedural pain and the implementation of the new protocol. Staff will complete a pre and post test. After a 1month baseline documentation of data on all infants requiring elective or semi-urgent intubation, the protocol change will be initiated. Data will then be collected on a total of 50 neonates receiving premedication.
Results
Analysis will include descriptive statistics and t-tests to compare the change in: knowledge of the staff regarding procedural pain in neonates, incidence of primary adverse physiologic effects (bradycardia and desaturations), time to successful intubation, and number of intubation attempts per infant.
Discussion
The goal of the project, which is currently being implemented, is to determine the efficacy of the procedural change.
Intubation is a painful and stressful procedure frequently performed in the NICU. This procedure may cause bradycardia, hypoxemia, and apnea. Few health care providers would consider intubating an adult or a young child without supporting pharmacologic measures, yet less than 1% of preterm infants in the NICUs of the United States receive premedication prior to this procedure. The purpose of this study is to evaluate the efficacy and safety of a change in the intubation protocol in one NICU in a teaching hospital in the eastern U.S. The protocol involves the administration of 1 dose (2mcg/kg) of Fentanyl to all infants prior to elective or semi-urgent intubation.
The evaluation will determine the efficacy of the protocol in: 1) increasing staff knowledge regarding neonatal procedural pain, 2) reducing the incidence of adverse physiologic effects (bradycardia and desaturations), 3) reducing the time to successful intubation and, 4) reducing the number of intubation attempts per neonate.
Methods
All staff involved in intubation procedures will attend one education session addressing neonatal procedural pain and the implementation of the new protocol. Staff will complete a pre and post test. After a 1month baseline documentation of data on all infants requiring elective or semi-urgent intubation, the protocol change will be initiated. Data will then be collected on a total of 50 neonates receiving premedication.
Results
Analysis will include descriptive statistics and t-tests to compare the change in: knowledge of the staff regarding procedural pain in neonates, incidence of primary adverse physiologic effects (bradycardia and desaturations), time to successful intubation, and number of intubation attempts per infant.
Discussion
The goal of the project, which is currently being implemented, is to determine the efficacy of the procedural change.