Respiratory Stabilization for Successful Intubation in Neonates: A Randomized Controlled Trial.
Deeksha Gupta, Poonam Singh, Mayank Priyadarshi et al.
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In 30 seconds
This randomized controlled trial assessed whether continuing pre-existing non-invasive respiratory support during endotracheal intubation (ETI) improved procedural stability in neonates of at least 26 weeks’ gestation requiring NICU intubation. Among 150 randomized neonates, first-attempt intubation without physiological instability occurred in 73.3% with respiratory support and 62.7% in room air; the difference was not statistically significant (relative risk 1.3 [0.7-1.7]; P = 0.161). Minimum oxygen saturation was lower and its decline greater in controls, while rates of desaturation, bradycardia and change in cerebral oxygen saturation did not differ.
Key findings
- First-attempt intubation without physiological instability occurred in 73.3% with support versus 62.7% in room air (relative risk 1.3 [0.7-1.7]; P = 0.161).
- Minimum SpO₂ was significantly lower, and its change from baseline significantly greater, in controls.
- Rates of desaturation, bradycardia and change in regional cerebral oxygen saturation did not differ between groups.
Why it matters
Intubation can be accompanied by oxygenation changes in neonates. This trial suggests that maintaining existing non-invasive support may help preserve oxygen saturation during the procedure, but it did not demonstrate a significant improvement in the primary outcome of first-attempt success without physiological instability. The distinction is relevant when interpreting a physiological benefit that did not translate into a statistically significant primary-outcome result.
What to keep in mind
Neonates with baseline bradycardia, life-threatening congenital anomalies or emergency intubation were excluded, limiting applicability to these groups.