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.