Neonatal tracheal intubation (TI) is a high-risk procedure associated with adverse safety events. In our newborn and infant ICU, we measure adverse tracheal intubation–associated events (TIAEs) as part of our participation in National Emergency Airway Registry for Neonates, a neonatal airway registry. We aimed to decrease overall TIAEs by 10% in 12 months.

A quality improvement team developed an individualized approach to intubation using an Airway Bundle (AB) for patients at risk for TI. Plan-do-study-act cycles included AB creation, simulation, unit roll out, interprofessional education, team competitions, and adjusting AB location. Outcome measure was monthly rate of TIAEs (overall and severe). Process measures were AB initiation, AB use at intubation, video laryngoscope (VL) use, and paralytic use. Balancing measure was inadvertent administration of TI premedication. We used statistical process control charts.

Data collection from November 2016 to August 2020 included 1182 intubations. Monthly intubations ranged from 12 to 41. Initial overall TIAE rate was 0.093 per intubation encounter, increased to 0.172, and then decreased to 0.089. System stability improved over time. Severe TIAE rate decreased from 0.047 to 0.016 in June 2019. AB initiation improved from 70% to 90%, and AB use at intubation improved from 18% to 55%. VL use improved from 86% to 97%. Paralytic use was 83% and did not change. The balancing measure of inadvertent TI medication administration occurred once.

We demonstrated a significant decrease in the rate of severe TIAEs through the implementation of an AB. Next steps include increasing use of AB at intubation.

新生儿气管插管 (TI) 是一种与不良安全事件相关的高风险手术。在我们的新生儿和婴儿 ICU 中，我们测量不良气管插管相关事件 (TIAE) 作为我们参与新生儿气道登记处国家紧急气道登记处的一部分。我们的目标是在 12 个月内将总体 TIAE 降低 10%。

一个质量改进团队为有 TI 风险的患者开发了一种使用气道束 (AB) 的个性化插管方法。计划-学习-行动周期包括 AB 创建、模拟、单元推出、跨专业教育、团队竞赛和调整 AB 位置。结果衡量标准是 TIAE 的每月发生率（总体和严重）。过程测量是 AB 启动、插管时 AB 使用、视频喉镜 (VL) 使用和麻痹使用。平衡措施是 TI 术前用药的无意管理。我们使用统计过程控制图。

2016 年 11 月至 2020 年 8 月的数据收集包括 1182 次插管。每月插管次数为 12 到 41。初始总体 TIAE 发生率为每次插管 0.093，增加到 0.172，然后下降到 0.089。系统稳定性随着时间的推移而提高。2019 年 6 月，严重 TIAE 发生率从 0.047 下降到 0.016。AB 起始率从 70% 提高到 90%，插管时 AB 使用率从 18% 提高到 55%。VL 使用率从 86% 提高到 97%。麻痹使用率为 83%，并且没有变化。无意的TI药物给药的平衡措施发生了一次。

我们证明通过实施 AB 可显着降低严重 TIAE 的发生率。下一步包括增加插管时 AB 的使用。