Assessing the Impact of Nasotracheal Intubation on Postoperative Neonates With Congenital Heart Disease: A Quality Improvement Project at a Single Heart Center

OBJECTIVES: Nasotracheal intubation (NTI) is associated with fewer unplanned extubations and improved oral motor skills compared with orotracheal intubation (OTI). Our study aimed to implement a practice change from OTI to NTI for neonatal cardiac surgery and assess impact on postoperative outcomes. DESIGN: Single-center, prospective, quality improvement study. SETTING: Academic children’s hospital. PATIENTS: One hundred thirty neonates undergoing cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: NTI during index cardiac surgery. MEASUREMENTS AND MAIN RESULTS: Data were collected between January 2019 and April 2021. The study was implemented in three phases: retrospective: OTI neonates (n = 43), I: safety and feasibility of NTI (n = 17), and II: speech language pathology (SLP) evaluation on postoperative day 1 facilitated by NTI (n = 70). Retrospective and phase I patients were combined for analysis. Groups were compared using Kruskal-Wallis test or Wilcoxon rank-sum test. Ninety-one percent of eligible neonates were nasotracheally intubated. There were no clinically significant complications. Days to first SLP encounter decreased from a median 4.5 days (interquartile range [IQR], 3.8–6.2) to 1.1 days (IQR, 1.0–1.9; p
Source: Pediatric Critical Care Medicine - Category: Pediatrics Tags: Online Cardiac Intensive Care Source Type: research