Ellen de Kort

24 Chapter 2 METHODS Literature searches in Pubmed and EMBASE were performed to obtain all publications evaluating the effect of premedication for intubation during the INSURE procedure. We searched for information about the intubation conditions, the number of attempts needed for successful intubation, and mainly the time to awakening and extubation. The initial search strategy involved the following keywords: “intubation, intratracheal” (MeSH), “premedication” (MeSH), and “INSURE”, with the limit newborn: birth-1 month. This search strategy revealed only two relevant publications. Therefore we performed an additional search strategy for all publications describing the INSURE procedure and screened these publications for the following information: premedication used, dose of premedication, intubation conditions, number of attempts needed for successful intubation, time to restoration of sufficient breathing pattern, time to extubation, time to start nasal respiratory support, INSURE failure, intractable apnea as a reason for INSURE failure, and time windowbetween extubation and INSURE failure. This search strategy involved the following keywords: “pulmonary surfactants” [MeSH], “respiratory distress syndrome, newborn” [MeSH], “positive pressure respiration” [MeSH], “continuous positive airway pressure” [MeSH], “infant, newborn” [MeSH], and “INSURE” in different combinations. Because the first publication describing the INSURE procedure appeared in 1990, publications in the time frame between January 1990 and June 2013 were sought. Because reviews describing the INSURE procedure do not usually provide any new data about premedication and its effects, we excluded reviews. Reference lists of publications describing the INSURE procedurewere screened for other useful publications. Publications in English, Dutch, French, and German were included. The full text of each report describing the INSURE procedure was screened for the abovementioned information. RESULTS The overall literature search yielded 12 studies suitable for our review. Only 2 publications, both byWelzing et al., explicitly evaluated the effect of premedication for intubation during the INSURE procedure, that is, remifentanil and propofol, respectively. 16,17 The search strategy for publications describing the INSURE procedure revealed 36 publications. We excluded 24 studies, 5 because they were written in another language (Danish, Swedish, and Chinese), 2 because any premedication before intubation clearly was not given, and 17 because they did not provide any information about the premedication