Ellen de Kort

94 Chapter 6 METHODS Study population This prospective two-center study was performed in the level III NICUs of the Erasmus MC Sophia Children’s Hospital, Rotterdam and Maxima Medical Center, Veldhoven, both in the Netherlands, between June 2015 and January 2017. Patients admitted to one of these NICUs were eligible for participation in this study if they needed (semi-) elective endotracheal intubation. The exclusion criterion was participation in other premedication studies at the same time. We used the NEAR4KIDS registry definitions regarding intubation encounters and attempts. An encounter is defined as one attempt of completed advanced airway management intervention including tracheal intubation. An attempt is defined as a single advanced airwaymaneuver beginningwith the insertion of the laryngoscope into the patient’s mouth and ending when the device is removed. 21 Because we allowed patients to be included in the analysis only once, we only included every first intubation attempt of every first intubation encounter per patient. Procedure Intubation was performed according to a standardized procedure. Propofol 1.0-2.0 mg/kg body weight was administered intravenously followed by a saline flush in 30 s. Immediately after propofol administration, IRS was assessed every 30 s by firmly rubbing the heel of the patients’ foot and grading the motor reaction to this stimulus (Table 1). Applying this stimulus and judging the reaction was always done by one of the team members performing the intubation procedure. Both scores 3 and 4 were presumed to indicate adequate sedation for the intubation procedure. Therefore, when a score of 3 or 4 was reached, intubation was proceeded. If the IRS was still 1 or 2 after 3 min, an additional dose of propofol was administered, and again IRS was assessed every 30 s. This procedurewas repeated until IRS 3 or 4 was reached. The time frame of 3 min before administering a new dose of medication was based on the known fast onset of action of propofol. Intubation was performed by pediatric residents, neonatal nurse specialists, fellows in neonatology, and neonatologists. Table 1. Intubation Readiness Score Score Motor reaction to firm stimulus 1 Spontaneous movement 2 Movement in reaction to slight touch 3 Movement in reaction to firm stimulus 4 No movement