Ellen de Kort

29 Sedation for the INSURE procedure 2 Definition of intubation conditions Definition of INSURE failure Predefined side effects Not defined Not defined Not defined Not defined Need for MV within 7 days of birth. Criteria for MV: a/A values <0.15 decreasing further over a period >30 min, severe apnea (>4 episodes of apnea/hour or need for bag and mask ventilation >2 times per hour), inability to extubate within 1 hour after INSURE Not defined Score 0-2 on coughing, breathing, and limb movements (≤1 = excellent, 2-3 = good, >3 or distinct coughing or limb movement = inacceptable) Not reported Hypotension Score 0-2 on coughing, breathing, and limb movements (≤1 = excellent, 2-3 = good, >3 or distinct coughing or limb movement = inacceptable) Not reported Hypotension, bradycardia, chest rigidity of attempts, and extubation time was not provided. Eight patients (19%) could not be extubated after surfactant administration. This was related to the premedication in only one patient, who received an overdose of pentobarbital. 23 Fentanyl. Four studies used fentanyl as premedication; two studies at a dose of 0.5–2 μg/ kg, 24,25 one study at a dose of 1–3 μg/kg, 26 and one study at a dose of 0.2 mg/kg. 27 None of these four studies detailed the intubation conditions, number of intubation attempts, and time to return of spontaneous breathing and extubation. The studies of Sandri et al. and Leone et al. also provided no information about INSURE failure. 24,27 In the study of Gizzi et al. INSURE failed in 11 patients (35%) who were extubated to nasal CPAP. In four patients the reason for INSURE failurewas intractable apnea and the time frame between surfactant administration and INSURE failure was 48.1 hours (range 5 - 72 hours).