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Rates of successful orotracheal intubation in infants when performed with a stylet versus without a stylet

Presented as a poster at the Neonatal Society 2016 Summer Meeting.

O’Gorman JR1, O’Shea JE1,2,3, O’Connell LAF2, Kamlin COF4,5, Davis PG5

1 Royal Hospital for Children, Glasgow, UK
2 Department of Newborn Research, The Royal Women’s Hospital, Melbourne, Australia
3 University College Cork, Ireland; Neonatal Services
4 Royal Women’s Hospital, Parkville, Australia
5 Murdoch Children’s Research Institute, Melbourne, Australia

Background: Neonatal endotracheal intubation is a common and potentially lifesaving intervention. It is a mandatory skill for neonatal trainees, but one that is difficult to master and maintain. Intubation opportunities for trainees are decreasing and success rates are subsequently falling. The use of a stylet may aid intubation and improve success. However potential for associated harm also needs to be considered.

Methods: We carried out a comprehensive search of the Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library, MEDLINE, EMBASE and CINAHL databases and clinical trial registries. Randomised, quasi – randomised trials or cluster randomised controlled trials comparing use versus non-use of stylet in neonatal orotracheal intubation met our selection criteria. Two review authors independently assessed the results of the searches against the predetermined criteria for inclusion, assessed risk of bias, and extracted data. We used the standard methods of The Cochrane Collaboration as documented in the Cochrane Handbook for Systemic Reviews of Interventions and the Cochrane Neonatal Review Group.

Results: One single centre non-blinded randomised control trial with a total of 302 intubation attempts in 232 infants was included. The median gestational age was 29 weeks. Intubation was performed by paediatric residents and fellows. We judged the study to be at low risk for bias overall. Investigators compared success rates of first-attempt intubation with and without use of a stylet. Success rates were reported as similar between the stylet and nostylet groups (57% and 53%) (P=.47). Success rates did not differ between groups in subgroup analyses by provider level of training and infant weight. There was no difference in the secondary review outcomes including duration of intubation, number of attempts, patient instability during the procedure and local airway trauma. Only 25% of all intubations took less than 30 seconds. The study does not report neonatal morbidity or mortality.

Conclusion: Based on current available evidence the use of a stylet when performing neonatal orotracheal intubation does not significantly improve the success rate among paediatric trainees.

Corresponding author: jennifer.o’gorman@nhs.net

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