Neonatal intubation

General considerations
  • Anatomical differences of neonates (compared to adults/big kids):
    • Large occiput--> may need shoulder roll to get ear to sternal notch aligned
    • Relatively larger tongue, small mouth
    • More anterior larynx
    • Larger/floppier epiglottis
    • Short trachea--> easy to mainstem tube, easy for accidental tube dislodgement
  • Cuffed vs uncuffed ETT: controversial[1] but cuffed tubes now genearlly considered acceptable[2]

Equipment/sizes/numbers
  • ETT tube size:
    • Full term newborn - 3.5-4 uncuffed
    • Preemie- gestational age in weeks/10 (e.g. 24-25wker gets a 2.5)
  • Blade:
    • Preemie <1.5kg: 00
    • Full term newborn: 0
    • Neonate/infant: 1
  • ETT depth
    • Newborn/neonate: uncuffed ETT x 3 (cm at lip)
    • Preemie: weight in kg +1 (cm at lip)
  • LMA size
    • Weight in kg/20 + 1
  • Apneic O2 by NC for newborn/neonate: 5L/m
  • Routine vent settings
    • FiO2 100%--> wean
    • PEEP 4-5
    • TV 8-10cc/kg
    • RR 25-35
    • I-time 0.5s

Drugs
  • Atropine premedication
    • Controversial
    • Neonates VERY prone to bradycardia with myriad stimuli, including the vagal stimulation of laryngoscopy
    • May not be needed routinely but should at least have handy in case of bradycardia[3]
    • 0.01-0.03 mg/kg IV/IO

See Also


References
  1. https://pedemmorsels.com/cuffed-endotracheal-tubes-in-children/
  2. American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.
  3. https://pedemmorsels.com/atropine-needed-rsi/
  4. https://reference.medscape.com/drug/ketalar-ketamine-343099
This article is issued from Wikem. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.