Team Stress and Adverse Events during Neonatal Tracheal Intubations: A Report from NEAR4NEOS

Rachel Umoren, Taylor Sawyer, Anne Ades, Stephen D. DeMeo, Elizabeth E. Foglia, Kristen Glass, Megan Gray, James Barry, Lindsay Johnston, Philipp Jung, Jae H. Kim, Jeanne Krick, Ahmed Moussa, Christine Mulvey, Vinay M. Nadkarni, Natalie Napolitano, Bin Huey Quek, Neetu Singh, Jeanne Zenge, Justine ShultsAkira Nishisaki

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Objective To examine the association between team stress level and adverse tracheal intubation (TI)-associated events during neonatal intubations. Study Design TIs from 10 academic neonatal intensive care units were analyzed. Team stress level was rated immediately after TI using a 7-point Likert scale (1 = high stress). Associations among team stress, adverse TI-associated events, and TI characteristics were evaluated. Result In this study, 208 of 2,009 TIs (10%) had high stress levels (score < 4). Oxygenation failure, hemodynamic instability, and family presence were associated with high stress level. Video laryngoscopy and premedication were associated with lower stress levels. High stress level TIs were associated with adverse TI-associated event rates (31 vs. 16%, p < 0.001), which remained significant after adjusting for potential confounders including patient, provider, and practice factors associated with high stress (odds ratio: 1.90, 96% confidence interval: 1.36–2.67, p < 0.001). Conclusion High team stress levels during TI were more frequently reported among TIs with adverse events.
Original languageEnglish (US)
JournalAmerican Journal of Perinatology
StatePublished - Jul 2019


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