Pediatric anesthesia & critical care
Ventilation strategies and risk factors for intraoperative respiratory critical events and postoperative pulmonary complications in neonates and small infants: a secondary analysis of the NECTARINE cohort☆
Authors' conclusion
Regardless of ventilation strategy used, mechanical ventilation and baseline respiratory conditions were risk factors for a greater incidence of adverse respiratory events and PPCs. Reversal of NMBAs before tracheal extubation was significantly associated with reduced PPCs in neonates
Study context
- Population
- Infants up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures (NECTARINE cohort)
- Participants
- 5,609 participants · 6,542 procedures
- Comparison
- Ventilation modes and NMBA use in relation to respiratory adverse events
- Primary endpoint
- Association between ventilation mode and intraoperative respiratory adverse events
Primary result
As reported in the abstract
Incidence of intraoperative respiratory critical events
20.7%
95% CI 19.7–21.7%
Pressure-controlled ventilation as primary ventilation modality
52.4% (n=3428) of cases
Secondary outcomes
Postoperative pulmonary complications (PPCs), absence of NMBA reversal
| Relative risk (95% CI) | ||
|---|---|---|
| Absence of reversalHigher incidence of PPCs | 1.50 (1.17–1.93) | |
| 0.512Relative risk (log scale) |
PPCs, NMBA reversal
| Relative risk (95% CI) | ||
|---|---|---|
| NMBA reversalReduced relative risk | 0.43 (0.26–0.70) | |
| 0.20.5125Relative risk (log scale) |
30-day PPCs (incidence)
- PPCs observed in cases
- 17%
- 95% CI 16.0-18.1%
Risk factors for PPCs
- Preanaesthesia respiratory conditions and NMBA use after tracheal intubation associated with higher incidence of PPCs
NMBA reversal rate among children receiving neuromuscular blocking agents (NMBAs)
- Reversal reported
- 29.8%
Original publication
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