{
  "abstract": "Objectives To compare success and safety of endotracheal tube (ETT) exchanges with primary intubations and identify factors associated with ETT exchange outcomes.Design Retrospective observational study of prospectively collected National Emergency Airway Registry for Neonates data. ETT exchanges are the placement of a new ETT when one is already in place, whereas primary intubations do not have a pre-existing ETT. The primary outcome was first-attempt success. Secondary outcomes included number of attempts, adverse tracheal intubation-associated events (TIAEs), severe TIAEs, desaturation and bradycardia. Descriptive statistics compared characteristics for ETT exchanges and primary intubations. Univariable and multivariable analyses compared primary and secondary outcomes and identified factors independently associated with ETT exchange outcomes.Results A total of 1572 ETT exchanges and 9999 primary intubations across 21 sites were included from October 2014 to September 2022. ETT exchanges represented 2.3%–31.2% (mean 13.6%) of intubations across sites. Patient, provider and practice characteristics varied significantly between ETT exchanges and primary intubations. In univariable analyses, ETT exchanges were associated with higher first-attempt success (70.5% vs 53.6%; p<0.001) and fewer safety events. In multivariable analyses, ETT exchanges were associated with an increased adjusted OR (aOR) of first-attempt success (1.71; 95% CI 1.57 to 1.86; p<0.001). ETT exchanges were associated with lower aOR of all safety outcomes except severe TIAEs. Factors independently associated with ETT exchange first-attempt success included video laryngoscopy and paralytic premedication.Conclusion Compared with primary intubations, ETT exchanges were associated with higher first-attempt success and fewer safety events. Video laryngoscope and paralytic premedication were associated with improved ETT exchange outcomes.",
  "authors": [
    {
      "affiliations": [
        "Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Kathleen Miller"
    },
    {
      "affiliations": [
        "Division of Neonatology, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA",
        "Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"
      ],
      "name": "Nicole Pouppirt"
    },
    {
      "affiliations": [
        "Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Paul Wildenhain"
    },
    {
      "affiliations": [
        "Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada"
      ],
      "name": "Ayman Abou Mehrem"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Ivana Brajkovic"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Neonatology, Yale University School of Medicine, New Haven, Connecticut, USA"
      ],
      "name": "Cassandra DeMartino"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Neonatology, Penn State Health Children’s Hospital/Penn State College of Medicine, Hershey, Pennsylvania, USA"
      ],
      "name": "Kristen Glass"
    },
    {
      "affiliations": [
        "Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia",
        "Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia"
      ],
      "name": "Kate Alison Hodgson"
    },
    {
      "affiliations": [
        "Department of Pediatrics, University Hospital Schleswig-Holstein, Luebeck, Germany"
      ],
      "name": "Philipp Jung"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Neonatology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada"
      ],
      "name": "Ahmed Moussa"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Neonatology, Seattle Children's Hospital, Seattle, Washington, USA"
      ],
      "name": "Mihai Puia-Dumitrescu"
    },
    {
      "affiliations": [
        "Division of Neonatology, KK Women's and Children's Hospital, Singapore"
      ],
      "name": "Binhuey Quek"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA"
      ],
      "name": "Jennifer Rumpel"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Neonatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA"
      ],
      "name": "Rebecca Shay"
    },
    {
      "affiliations": [
        "Royal Children’s Hospital, Melbourne, Victoria, Australia",
        "Neonatology, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia"
      ],
      "name": "David Tingay"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Neonatology, Dartmouth Health Children's, Lebanon, New Hampshire, USA"
      ],
      "name": "Michelle D Tyler"
    },
    {
      "affiliations": [
        "Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada",
        "Department of Pediatrics, Division of Neonatology, Alberta Children's Hospital, Calgary, Alberta, Canada"
      ],
      "name": "Jennifer Unrau"
    },
    {
      "affiliations": [
        "Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care, and Pediatric Neurology, Medical University Vienna, Vienna, Austria"
      ],
      "name": "Michael Wagner"
    },
    {
      "affiliations": [
        "Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA",
        "Division of Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Justine Shults"
    },
    {
      "affiliations": [
        "Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Akira Nishisaki"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Neonatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA",
        "Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Elizabeth E Foglia"
    },
    {
      "affiliations": [
        "Department of Pediatrics, Division of Neonatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA",
        "Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Heidi M Herrick"
    }
  ],
  "title": "Success and safety of neonatal endotracheal tube exchanges: a NEAR4NEOS multicentre retrospective cohort study",
  "uid": "bc032e31-73f1-5539-9fb2-aa3bd93aa1c1"
}