Reducing tracheal intubation adverse events and severe desaturations by increasing intubation premedication use in infants <1500 g: a quality improvement initiative.
Publication/Presentation Date
11-24-2025
Abstract
BACKGROUND: Tracheal intubation in very low birth weight (VLBW) infants is a high-risk procedure associated with tracheal intubation adverse events (TIAEs). Premedication for non-emergent intubations typically includes a vagolytic and analgesic agent. Rapid sequence intubation (RSI), defined as premedication with a vagolytic, analgesic, and paralytic agent, is used to enhance procedural safety and reduce complications. Premedication without paralysis was used for infants receiving surfactant with immediate extubation.
OBJECTIVE: To increase the use of premedication and RSI in VLBW infants and reduce adverse events.
METHODS: A QI initiative targeting VLBW infants at a level IV NICU undergoing non-emergent intubations. Interventions included forming a multidisciplinary team, education, and implementing an EHR-pathway with embedded orders.
RESULTS: Premedication use increased from 25.7% to 93.4%, and RSI use from 14.6% to 77.3%. TIAEs decreased from 41.4% to 14.4%, and severe desaturations from 32% to 11.2%.
CONCLUSIONS: Standardizing premedication practices, including RSI, can improve neonatal safety.
ISSN
1476-5543
Published In/Presented At
Daniel, J., Johnston, L. C., DeMartino, C., Blythe, E., Beres, S., Garcia, C., & Fleiss, N. (2025). Reducing tracheal intubation adverse events and severe desaturations by increasing intubation premedication use in infants <1500 g: a quality improvement initiative. Journal of perinatology : official journal of the California Perinatal Association, 10.1038/s41372-025-02517-5. Advance online publication. https://doi.org/10.1038/s41372-025-02517-5
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
41286422
Department(s)
Department of Pediatrics
Document Type
Article