Nasal High-Flow therapy Ups Intubation Success in First Attempt Among Neonates

Neonatal endotracheal intubation often involves more than one attempt, and oxygen desaturation is common. The benefit of high-flow therapy during intubation in neonates, who often undergo intubation urgently and who frequently have underlying lung disease remain understudied. Therefore, Dr Kate A. Hodgson and her team conducted a study to assess whether high-flow therapy during oral neonatal endotracheal intubation improves the likelihood of successful intubation on the first attempt without physiological instability in the infant.

In this randomized, controlled study, the researchers assessed the outcomes of 251 intubations in 202 infants; 124 intubations were assigned to the high-flow group and 127 to the standard-care group. randomization of intubations to the high-flow group or the standard-care group was stratified according to trial centre, the use of premedication for intubation (yes or no), and postmenstrual age of the infant (≤28 or >28 weeks). The major outcome assessed was successful intubation on the first attempt without physiological instability (defined as an absolute decrease in the peripheral oxygen saturation of >20% from the pre-intubation baseline level or bradycardia with a heart rate of <100 beats per minute) in the infant.

Key findings of the study:

• Upon analysis, the researchers found that the successful intubation on the first attempt without physiological instability was achieved in 62 of 124 intubations (50.0%) in the high-flow group and 40 of 127 intubations (31.5%) in the standard care group (adjusted risk difference, 17.6 %), for a number needed to treat of 6 for 1 infant to benefit.
• They noted that the successful intubation on the first attempt regardless of physiological stability was accomplished in 68.5% of the intubations in the high-flow group and 54.3% of the intubations in the standard-care group (adjusted risk difference, 15.8%).

The authors concluded, "Among infants undergoing endotracheal intubation at two Australian tertiary neonatal intensive care units, nasal high-flow therapy during the procedure improved the likelihood of successful intubation on the first attempt without physiological instability in the infant."

For further information:

DOI:10.1056/NEJMoa2116735