Ellen de Kort

61 Less Invasive Surfactant Administration without sedation 4 -20 -15 -10 -5 5 10 15 20 25 30 140 145 150 155 160 165 170 175 180 Good technical conditions Inadequate technical conditions a.Heart rate - quality of technical conditions Start LISA Time from start of LISA (min) Heart rate (beats/ min) -20 -15 -10 -5 5 10 15 20 25 30 140 145 150 155 160 165 170 175 180 Successful first attempt Failed first attempt b.Heart rate - successof first attempt Start LISA Time from start of LISA (min) Heart rate (beats/ min) -20 -15 -10 -5 5 10 15 20 25 30 60 65 70 75 80 85 90 95 100 Good technical conditions Inadequate technical conditions c.Oxygen saturation - quality of technical conditions Start LISA Time from start of LISA (min) Oxygen saturation (%) -20 -15 -10 -5 5 10 15 20 25 30 60 65 70 75 80 85 90 95 100 Succesful first attempt Failed first attempt d.Oxygen saturation - success of first attempt Start LISA Time from start of LISA (min) Oxygen saturation (%) Figure 3. Heart rate and oxygen saturation in relation to the success rate and quality of intubation Light grey areas indicate the period from which baseline heart rate and oxygen saturation were calculated. DISCUSSION This observational study was performed to assess the quality and effect on vital parameters of LISA procedures performed without the use of sedative premedication. LISA performed in awake patients had a low success rate of the first attempt, and the technical quality was frequently inadequate. Also, there was a significant correlation between failure of the first attempt and the quality of technical conditions, suggesting patient discomfort and intolerance as a cause for first attempt failure. Besides this, there was a high frequency of oxygen desaturations. Combined with the extensive existing evidence on the harmful effects of awake laryngoscopy during endotracheal intubation, our results emphasize the need for better pain reduction and patient comfort during LISA by using sedative premedication.