INTRODUCTION
Endotracheal intubation is a high-risk, life-saving procedure
implemented during resuscitation and respiratory
support.1 Intubation procedures are associated with
certain changes in physiology, including hypoxia or vagal-induced
bradycardia, hypertension, and increased intracranial blood pressure,
which may cause damage to the immature and developing neonatal
brain.2 Difficult intubations (≥3) are common in the
neonatal intensive care unit (NICU) and are associated with adverse
events and severe oxygen desaturation.3 Moreover, less
experience in the intubation procedure is associated with an increased
duration of intubation attempts, severe desaturation,
intubation-associated adverse events, and lower success rates in
intubation.4 Physiological stability during
intubation, therefore, protects the infant from damage, particularly
during difficult and prolonged intubation.
Although there are several studies conducted in
adults,5 few studies have been conducted with neonates
to explore how to reduce physiological changes during
intubation.6-8 In one of these few studies conducted
with preterm infants, Hodgson et al.6 reported that
nasal high-flow (NHF) therapy during the intubation improved the
likelihood of successful intubation on the first attempt without causing
physiological instability. Foran et al.7 reported that
the rate of decline in oxygen saturation was lower when using NHF during
intubation. Another study with a relatively smaller sample size
postulated that continuous gas flow via the endotracheal tube during
intubation is favorable.8
In neonates, nasal intermittent positive pressure ventilation (NIPPV)
increases the mean airway pressure and reopening of the partially
collapsed airways, improves minute ventilation and functional residual
capacity, and reduces the frequency of bradycardia, apnea, and oxygen
desaturation episodes.9,10 NIPPV prevents treatment
failure and decreases the requirement for mechanical ventilation and
reintubation rates compared to the use of continuous positive airway
pressure and NHF.10 However, different from previous
studies,6-8 the present study involved the use of
NIPPV as it is one of the most used non-invasive ventilation modalities
in NICUs and offers several benefits.
The present study aimed to determine whether the use of NIPPV during
endotracheal intubation increases the rate of successful intubation
without physiological instability during all intubation attempts in
neonates.