The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

ENDOTRACHEAL INTUBATION AND MECHANICAL VENTILATION CAN GENERALLY BE AVOIDED IN NEONATES UNDERGOING LASER SURGERY FOR RETINOPATHY OF PREMATURITY. 

Debra Molloy RRT RN, Daniel D. Woodhead RRT, Diane K. Lambert RN, Cami Allen RT, Heidi Voorhess

RRT, Gorgi D.Rigby RRT, S.Lynn Port RRT, Vicki L.Baer RN, Robert D.Christensen MD. Intermountain Healthcare Clinical Research, the McKay-Dee Hospital Center, Ogden UT, LDS Hospital, Salt Lake City, UT, and Utah Valley Regional Medical Center, Provo, UT. 

Background. During and following laser surgery for retinopathy of prematurity (ROP), it is common to use endotracheal intubation and mechanical ventilation for respiratory support. However, since virtually all patients with ROP have chronic lung disease, it can be difficult to extubate these patients after surgery, thus many days of postoperative ventilation are occasionally needed. In 2002 the NICU McKay-Dee Hospital postulated an alternative method of ventilatory support during surgery; namely whenever possible long nasopharyngeal prongs were used rather than an endotracheal tube, thus avoiding intubation and the problems of weaning from the ventilator. We postulated that the nasopharyngeal prongs were less invasive, would decrease mechanical ventilation days, and would be less expensive than endotracheal intubation and mechanical ventilation. The present study was undertaken as an analysis of outcomes of all neonates managed for ROP surgery during the past 48 months. 

Methods. This study is an historic cohort analysis of all neonates undergoing ROP surgery during their NICU in-patient stay at any of three level III NICUs between January 1, 2002 and January 31, 2006. Data collected included gestational age at delivery, birth weight, respiratory diagnosis on admission, and day of life ROP Surgery was preformed, intubated (yes/no) for the ROP surgery, respiratory modality used during ROP surgery, respiratory modality during the three days after ROP surgery, and respiratory care charges on the day of surgery and for the next three days.

Results. Fifty-six neonates underwent ROP surgery during this period. Of these, 23 were at LDS hospital or Utah Valley Regional Medical Center and all were intubated for surgery. Of the 33 who had surgery at McKay-Dee Hospital seven were intubated surgery and 25 were not. The birth weight of those who were intubated did not differ from those who were not (657±177 vs. 737±178) grams (mean±SD). Similarly, the gestational age at birth did not differ (25.2±1.9 vs. 25.4±1.2) weeks, days. We could not identify reasons why the eight were intubated and we postulate that this was at the volition of the anesthesiologist. Only one of the 25 who were not intubated for surgery required endotracheal intubation after surgery and remained on mechanical ventilation two additional days. The average length of postsurgical mechanical ventilation for the intubated group was 1.7±1.0 days. Respiratory care charges for the day of surgery and the following three days averaged $1988 more for the
intubated patients. 

Conclusions.
Many neonates who require laser surgery for ROP can be supported intraoperatively and postoperatively by nasopharyngeal prongs and do not need endotracheal intubation with mechanical ventilation. This approach will reduce the days of mechanical ventilation and will diminish hospital charges.

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