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RESEARCH PRODUCT

Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE)

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Background: Neonates and infants are susceptible to hypoxaemia in the perioperative period. The aim of this study was to analyse interventions related to anaesthesia tracheal intubations in this European cohort and identify their clinical consequences. Methods: We performed a secondary analysis of tracheal intubations of the European multicentre observational trial (NEonate and Children audiT of Anaesthesia pRactice IN Europe [NECTARINE]) in neonates and small infants with difficult tracheal intubation. The primary endpoint was the incidence of difficult intubation and the related complications. The secondary endpoints were the risk factors for severe hypoxaemia attributed to difficult airway management, and 30 and 90 day outcomes. Results: Tracheal intubation was planned in 4683 procedures. Difficult tracheal intubation, defined as two failed attempts of direct laryngoscopy, occurred in 266 children (271 procedures) with an incidence (95% confidence interval [CI]) of 5.8% (95% CI, 5.1e6.5). Bradycardia occurred in 8% of the cases with difficult intubation, whereas a significant decrease in oxygen saturation (SpO2<90% for 60 s) was reported in 40%. No associated risk factors could be identified among comorbidities, surgical, or anaesthesia management. Using propensity scoring to adjust for confounders, difficult anaesthesia tracheal intubation did not lead to an increase in 30 and 90 day morbidity or mortality. Conclusions: The results of the present study demonstrate a high incidence of difficult tracheal intubation in children less than 60 weeks post-conceptual age commonly resulting in severe hypoxaemia. Reassuringly, the morbidity and mortality at 30 and 90 days was not increased by the occurrence of a difficult intubation event. Clinical trial registration: NCT02350348. © 2021 The Authors. Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. All Rights Reserved. European Space Agency; European Society of Anaesthesiology This study is registered with ClinicalTrials.gov (NCT02350348). Detailed study design and data collection for the NECTARINE were previously published. 7 , 8 In summary, NECTARINE is a multicentre/multinational European, prospective, observational cohort study funded by the European Society of Anaesthesiology (ESA) through the Clinical Trial Network (CTN) grant and collected perioperative data that described the anaesthesia management of children aged from birth to 60 weeks PCA. Participating centres were selected through a ‘call for centre’ launched by the ESA, and after ethics approval recruited patients during a 3 month period between March 1, 2016 and January 31, 2017. The authors acknowledge all participating centres and staff for making the NECTARINE study successful. We also thank the Research Team at the ESA for providing the infrastructure for the trial, identifying the national study coordinating investigators, liaising with the local investigators regarding their ethics submission process and the inclusion period, and monitoring the data entry and cleaning.