Abstract
Objective This study aims to test whether implementing a guideline for nonemergent intubation
improves the rate of premedication for nonemergent intubations in an academic level
IV neonatal intensive care unit (NICU). We further sought to test the hypothesis that
neonates who receive premedication for a nonemergent intubation have decreased pain
scores at the time of intubation, fewer intubation attempts, and no associated adverse
events.
Study Design This was a prospective observational study with ongoing audit and feedback as well
as statistical process control analysis. Data collection began on October 1, 2014.
Clinical guideline implementation began in October 2015. A percent “P”-chart spanning
seven-quarters was constructed with statistical process control analysis plotting
premedication rates over time. Student's t-tests or Wilcoxon rank-sum tests were used for secondary outcomes.
Results The mean number of nonemergent intubations given premedications increased from 34
to 82%. The mean pain score was lower when premedications were given: 0.34 (95% confidence
interval [CI]: 0.10–0.58) versus 2.8 (95% CI: 1.9–3.6) (p < 0.001). The number of intubation attempts did not differ with premedications.
Conclusion Adopting a guideline with supporting educational initiatives to standardize premedication
before nonemergent intubations increased this practice. This regimen lowered clinical
pain scores with no difference in the number of intubation attempts.
Keywords
neonates - nonemergent intubation - guidelines - quality improvement
