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Survey of current intubation practices in Polish neonatal and pediatric ICUs

Introduction

Guidelines pertaining to the details of intubation practices in neonates and children are not well established. We sought to describe the current practices with regard to the intubation of newborns and children.

Methods

The study was performed in 2007. Anonymous questionnaires were sent out to all Polish neonatal (n = 418) and pediatric (n = 45) ICUs. The overall response rate was 65%. The response rate in level III of neonatal care was 86.7% and in the pediatric ICU (PICU) was 65.1%. The responders were asked to provide information regarding the frequency of specific practices. Data analysis (the difference between neonatal units and PICUs) was performed by means of procedures available in SAS software.

Results

Seventy-four percent of neonatal units and 89.3% of PICUs have a policy for elective intubation. Only a part of the units has a written policy (from 48% in level III neonatal ICUs to 19.4% in level I neonatal units). Unplanned extubation was found an important problem in 3.0% of neonatal units and 7.1% of PICUs (P = 0.05). A written protocol for difficult airways intubation was available in 48.1% of PICUs and 3.0% of neonatal units (P = 0.0001). In total, 92.2% of PICUs have regular sedative practices for elective intubation. Only 44.6% of neonatal units have such a policy (P = 0.0001). Numerous combinations of either sedatives or muscle relaxants were found to be used by units. However the most common policy in neonatal units (69.0%) was a single dose of midazolam. Combination of thiopental or midazolam, muscle relaxant and/or atropine was used frequently (79.4%) in PICUs. Only 74% of PICUs and 37.5% of neonatal ICUs have a policy for elective extubation (P = 0.0001).

Conclusion

When compared with similar studies, a lower number of Polish neonatal and pediatric ICUs have a written policy for elective intubation. Only a minority of PICUs fail to provide any sedation prior to elective intubation. More than one-half of neonatal units have no such policy despite strong evidence of physiologic and practical benefits. This phenomenon was found also by others. A lack of written guidelines for the extubation procedure is another finding for a future educational programme.

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Keywords

  • Midazolam
  • Atropine
  • Muscle Relaxant
  • Thiopental
  • Difficult Airway