• Jennifer Marietta, Kristi L Glotzbach, Courtney E Jones, Zhining Ou, Tiffany K Profsky, Dave Clegg, Melissa M Winder, and Charles G Pribble.
• Primary Children's Hospital, Heart Center, Salt Lake City, UT.
• Pediatr Crit Care Me. 2022 Jul 1; 23 (7): e338-e346.

ObjectivesNasotracheal intubation (NTI) is associated with fewer unplanned extubations and improved oral motor skills compared with orotracheal intubation (OTI). Our study aimed to implement a practice change from OTI to NTI for neonatal cardiac surgery and assess impact on postoperative outcomes.DesignSingle-center, prospective, quality improvement study.SettingAcademic children's hospital.PatientsOne hundred thirty neonates undergoing cardiac surgery with cardiopulmonary bypass.InterventionsNTI during index cardiac surgery.Measurements And Main ResultsData were collected between January 2019 and April 2021. The study was implemented in three phases: retrospective: OTI neonates ( n = 43), I: safety and feasibility of NTI ( n = 17), and II: speech language pathology (SLP) evaluation on postoperative day 1 facilitated by NTI ( n = 70). Retrospective and phase I patients were combined for analysis. Groups were compared using Kruskal-Wallis test or Wilcoxon rank-sum test.Ninety-one percent of eligible neonates were nasotracheally intubated. There were no clinically significant complications. Days to first SLP encounter decreased from a median 4.5 days (interquartile range [IQR], 3.8-6.2) to 1.1 days (IQR, 1.0-1.9; p < 0.001). Oral readiness time decreased from a median of 6.6 days (IQR, 5.4-8.9) to 4.3 days (IQR, 3.4-8.6; p < 0.001). .ConclusionsNTI is feasible and safe in neonatal cardiac surgery. System-level engagement with stakeholders is necessary to change clinical practice. NTI facilitates early SLP evaluation and treatment and significantly affects oral readiness after neonatal cardiac surgery.Copyright © 2022 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

30 keywords...

hide…