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.