Fuchs, A;
Disma, N;
Engelhardt, T;
Marchesini, V;
Riedel, T;
Boda, K;
Habre, W;
... Magne, C; + view all
(2025)
Ventilation strategies and risk factors for intraoperative respiratory critical events and postoperative pulmonary complications in neonates and small infants: a secondary analysis of the NECTARINE cohort.
British Journal of Anaesthesia
10.1016/j.bja.2024.12.038.
(In press).
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Abstract
BACKGROUND: Optimal ventilation strategies and use of neuromuscular blocking agents (NMBAs) in neonates and small infants undergoing anaesthesia remain unclear. We examined the association of perioperative ventilation strategies and administration of NMBAs on respiratory adverse events in the NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) cohort. METHODS: We performed a secondary analysis of NECTARINE, which included infants up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures. The primary endpoint was the association between ventilation mode and intraoperative respiratory adverse events. Secondary endpoints were use of NMBA, and 30-day postoperative pulmonary complications (PPCs). RESULTS: The dataset comprised 5609 patients undergoing 6542 procedures. Pressure-controlled ventilation was the primary ventilation modality, accounting for 52.4% (n=3428) of cases. The incidence of intraoperative respiratory critical events was 20.7% (95% confidence interval [CI] 19.7–21.7%), while PPCs were observed in 17% of cases (95% CI 16.0–18.1%). Preanaesthesia respiratory conditions and NMBA use after tracheal intubation were associated with higher incidence of PPCs. Of the children receiving NMBAs, reversal was reported in 29.8%. The absence of reversal was associated with a higher incidence of PPCs, with a relative risk of 1.50 (95% CI 1.17–1.93). Conversely, NMBA reversal was associated with a reduced relative risk of 0.43 (95% CI 0.26–0.70). CONCLUSIONS: Regardless of ventilation strategy used, mechanical ventilation and baseline respiratory conditions were risk factors for a greater incidence of adverse respiratory events and PPCs. Reversal of NMBAs before tracheal extubation was significantly associated with reduced PPCs in neonates and should be routine clinical practice. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT02350348)
| Type: | Article |
|---|---|
| Title: | Ventilation strategies and risk factors for intraoperative respiratory critical events and postoperative pulmonary complications in neonates and small infants: a secondary analysis of the NECTARINE cohort |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.bja.2024.12.038 |
| Publisher version: | https://doi.org/10.1016/j.bja.2024.12.038 |
| Language: | English |
| Additional information: | © 2025 The Author(s). Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). |
| Keywords: | Intraoperative respiration; mechanical ventilation; neonate; neuromuscular blocking agent; paediatric; postoperative pulmonary complications; respiratory adverse events |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Neurosciences Dept |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10206319 |
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