Ellen de Kort

93 Evaluation of an Intubation Readiness Score 6 INTRODUCTION Endotracheal intubation is a frequently performed distressing procedure in the Neonatal Intensive Care Unit (NICU), and potentially complicated by a number of serious adverse physiological events. 1-7 Adequate sedation by the use of premedication before intubation may prevent these adverse events, reduces the duration and number of attempts needed for successful intubation, and prevents traumatic injury to the airway. 3,6-11 Routine use of premedication before (semi-)elective intubation has increased over the past decades. 12-18 The main goal of premedication is to achieve an adequate level of sedation to facilitate the intubation procedure. Therefore, intubation should not be started until this level of sedation is achieved. However, there is no clear definition about the target level of sedation, and the assessment of sedation is often subjective and may vary between clinicians. The literature does not provide validated tools to assess the pre-intubation level of sedation. 19 In their study to evaluate the effect ofmethohexital as premedication in neonatal intubation, Naulaers et al. described the effect of methohexital on sedation, relaxation, and sleep. 20 The level of sedation was assessed as the motor response to a firm stimulus (heel- rubbing) and four degrees of reactions were defined: “moves spontaneously,” “moves when touched,” “moves when stimulated,” and “no reaction to stimulus.” Relaxation was assessed by evaluating muscle tone in arms and legs, using four categories: “hypotonic,” “mildly hypotonic,” “normal tone,” and “hypertonic.” The degree of sleep was noted as “awake,” “easily woken,” and “deep asleep.” The results of this study show that the level of sedation, degree of muscle relaxation, and degree of sleep correlate very well. 20 Therefore, we judged the motor reaction to a firm stimulus to be a very useful and easy- to-perform score to assess the pre-intubation level of sedation and named this score the Intubation Readiness Score (IRS). The aim of our study was to evaluate the suitability of this IRS in adequately indicating the pre-intubation sedation level by correlating the IRS to the quality of intubation. We hypothesized that the IRS performed after the administration of premedication would adequately predict Viby-Mogensen intubation scores during intubation.