Please enable JavaScript.
Coggle requires JavaScript to display documents.
Rapid Sequence Intubation in the NICU (Barriers to Policy and Procedure…
Rapid Sequence Intubation
in the NICU
Barriers to Policy
and Procedure change
Long term effects of pre-medications are unknown
Provider/staff knowledge
Provider/staff attitude
Resources
Habit
Fear of chest wall rigidity
Intubating Conditions
Emergency
IV access not available
IM route consideration
Feasibility of access to medications
Delivery room intubations
RSI specific kits?
Non-Emergency
Excellent Intubating Conditions
Good jaw relaxation
Open and immobile vocal cords
Suppression of pharyngeal and laryngeal reflexes by blunting coughing or diaphragmatic movement in response to intubation
Ethics
Would we intubate adult
patients without sedation or analgesia?
Current Recommendations
American Academy of Pediatrics Recommendation
2010 AAP released clinical report for premedication for non-emergent endotracheal intubations in the neonate
Except for emergent intubation during resuscitation either in the delivery room or after acute deterioration or critical illness at a later age, premedication should be used for all endotracheal intubations in newborns
Potential Gaps
in Knowledge
Medications
Analgesic agents or anesthetic dose of a hypnotic drug should be given
Vagolytic agents and rapid-onset muscle relaxants should be considered.
Use of sedative alone such as benzodiazepines without analgesia should be avoided
A muscle relaxant without an analgesic agent should not be used
Medications with rapid onset and short duration of action are preferable
What are the best choice of medications?
What is the best sequence of administration?
Time and speed of administration?
Proven Benefits
Facilitate better intubating conditions
Decrease the number and times of attempts
Fewer changes in baseline heart rate/ blunting of SNS stimulation
Decreased number of intubation-realated airway truma
Neonates experience with intubation
Hypoxemia
Bradycardia
Increased ICP - higher risk of IVH
Systemic and pulmonary hypertension
Potential damage to airway with laryngoscopy
Multidisciplinary Planning
Pharmacy involvement to ensure access to overriding medication or medication availability in a timely fashion
Lists of preferred medications to improve compliance and minimize medication errors and adverse events
Protocol development
Creation of order set