Browse by author
Lookup NU author(s): Dr Lisa Daniels, Dr Monica Gandhi, Dr David Pachter, Dr Andrew Robertson, Lucy Sedlackova
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2025 The Author(s)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).
Author(s): Fuchs A, Disma N, Engelhardt T, Riedel T, Boda K, Habre W, Riva T, NECTARINE Steering Committee, Daniels L, Gandhi M, Pachter D, Robertson A, Sedlackova L
Publication type: Article
Publication status: Published
Journal: British Journal of Anaesthesia
Year: 2025
Pages: epub ahead of print
Online publication date: 20/02/2025
Acceptance date: 10/12/2024
Date deposited: 05/03/2025
ISSN (print): 0007-0912
ISSN (electronic): 1471-6771
Publisher: Elsevier Ltd
URL: https://doi.org/10.1016/j.bja.2024.12.038
DOI: 10.1016/j.bja.2024.12.038
Notes: NECTARINE Group of the European Society of Anaesthesiology and Intensive Care Clinical Trial Network.
Altmetrics provided by Altmetric
