Indications:
- NRP - apnea, bradycardia, cyanosis
- Hypoxic or hypercapnic respiratory failure
Preparation :
-
Equipment:
-
Laryngoscope
-
Direct laryngoscope
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Video laryngoscope: C-MAC, NeoView, Glidescope
Left to right: direct laryngoscope with Miller blade, C-MAC, Glidescope
NeoView
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Miller blade is the standard for neonatal intubation.
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ETT and Blade sizes is based on weight
| Weight (kg) |
ETT size |
Miller blade |
| <1kg |
2.5 |
00 |
| 1-2kg |
3.0 |
0 |
| >2kg |
3.5 |
0 or 1 |
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“1-2-3” 1-2kg = 3.0 ETT
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“Blade No. 1 term, 0 preterm, 00 extremely preterm”
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If you don’t know the EFW, just estimate from the GA.
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Malleable stylet is optional, if used make sure the tip of the stylet doesn’t protrude out the ETT
-
Checklist for RN, RT, MD:
NICCU Intubation Checklist 3.15.21.pdf
Steps:
- Premedication (if not intubated for NRP):
- Preoxygenate
- Position
- Insert
- Check for proper ETT placement:
- Secure the ETT in place (there are many ways, no evidence about the most effective way)
- Confirmation
Initially difficult to see due to secretions, cleared up after suctioning. Miller blade tip lifted up on vallecula.
Initially difficult to see due to secretions, cleared up after suctioning. Miller blade tip lifted up on vallecula.
Secretions cleared by suction. Miller blade lifted up the epiglottis. OG helps provide esophagus anatomical landmark.
Secretions cleared by suction. Miller blade lifted up the epiglottis. OG helps provide esophagus anatomical landmark.
Less-Invasive Surfactant Administration using thin angiocath catheter. OG provides an esophagus landmark. Vocal cords are seen clearly moving actively. Excessive lung fluid in this IDM late-preterm newborn at 3HOL with RDS requiring high NIPPV and FiO2.
Less-Invasive Surfactant Administration using thin angiocath catheter. OG provides an esophagus landmark. Vocal cords are seen clearly moving actively. Excessive lung fluid in this IDM late-preterm newborn at 3HOL with RDS requiring high NIPPV and FiO2.
Laryngeal mask airway (LMA)